Controversies in HIV-associated neurocognitive disorders

Sam Nightingale, Alan Winston, Scott Letendre, Benedict D. Michael, Justin C. McArthur, Saye Khoo, Tom Solomon

Research output: Contribution to journalReview articlepeer-review

Abstract

Cross-sectional studies show that around half of individuals infected with HIV-1 have some degree of cognitive impairment despite the use of antiretroviral drugs. However, prevalence estimates vary depending on the population and methods used to assess cognitive impairment. Whether asymptomatic patients would benefit from routine screening for cognitive difficulties is unclear and the appropriate screening method and subsequent management is the subject of debate. In some patients, HIV-1 RNA can be found at higher concentrations in CSF than in blood, which potentially results from the poor distribution of antiretroviral drugs into the CNS. However, the clinical relevance of so-called CSF viral escape is not well understood. The extent to which antiretroviral drug distribution and toxicity in the CNS affect clinical decision making is also debated.

Original languageEnglish (US)
Pages (from-to)1139-1151
Number of pages13
JournalThe Lancet Neurology
Volume13
Issue number11
DOIs
StatePublished - Nov 1 2014

ASJC Scopus subject areas

  • Clinical Neurology

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