title: Guidelines for Evaluation and Management of Cognitive Disorders in HIV-Positive Individuals.
abstract: Antiretroviral therapy has revolutionised the treatment for people living with HIV (PLWH). Where antiretroviral coverage is high, the treatment paradigm for HIV-disease is now one of managing the long-term consequences of the virus and its treatment rather than the consequences of untreated HIV-disease such as immunosuppression and opportunistic infections. One such long-term consequence is HIV-associated cognitive impairment which is reported to occur in up to 50 % of treated PLWH and has been associated with poorer outcomes. Given the ageing cohort and increased frequency of comorbidities, the prevalence of symptomatic cognitive impairment may increase with time. High quality evidence for management strategies including screening, diagnosis and treatment of HIV-associated cognitive impairment are lacking and in general guidelines are based on best clinical practice. In this article, we assessed recent guidelines concerning the management of HIV-associated cognitive impairment by performing a systematic review of the MEDLINE database using PubMed. We report that, in general, guidelines from around the world regarding the management of HIV-associated cognitive impairment are converging. Screening is generally not recommended in asymptomatic PLWH. Diagnosis of HIV-associated cognitive impairment should be made only after a comprehensive assessment and exclusion of other potential causes. Antiretroviral therapy forms the cornerstone of management of HIV-associated cognitive impairment and should be guided by plasma and cerebrospinal fluid (CSF) genotype(s).
authors.affiliation: Division of Infectious Diseases, Imperial College London, London, UK. jonathan.underwood@imperial.ac.uk.|Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, London, W2 1NY, UK. jonathan.underwood@imperial.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Underwood
authors.affiliation: Division of Infectious Diseases, Imperial College London, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Winston
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D000375:Aging; D016229:Amyloid beta-Peptides / Q000097:blood / Q000134:cerebrospinal fluid; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy* / Q000821:virology; D060825:Cognitive Dysfunction / Q000150:complications / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D010446:Peptide Fragments / Q000097:blood / Q000134:cerebrospinal fluid; D017410:Practice Guidelines as Topic; D011379:Prognosis
chemical_list: D016229:Amyloid beta-Peptides; D019380:Anti-HIV Agents; D015415:Biomarkers; D010446:Peptide Fragments
keywords: Cognitive impairment; Guidelines; HIV; HIV-associated cognitive disorder