TY - JOUR
T1 - Controversies in HIV-associated neurocognitive disorders
AU - Nightingale, Sam
AU - Winston, Alan
AU - Letendre, Scott
AU - Michael, Benedict D.
AU - McArthur, Justin C.
AU - Khoo, Saye
AU - Solomon, Tom
N1 - Funding Information:
SK has received research grants from Merck, ViiV, Gilead, Abbott, Janssen, Boehringer, Vertex, and Bristol-Myers Squibb in support of research and HIV drug interactions resource , and travel bursaries, speakers bureau, and consultancy. AW has received honoraria or research grants, and has been a consultant or investigator in clinical trials sponsored by Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Janssen Cilag, Roche, and Pfizer. Abbvie, Merck, Janssen, and GlaxoSmithKline have provided funding to University of California, San Diego for investigator-initiated research on behalf of SL. SN, BDM, JCM, and TS declare no competing interests.
Funding Information:
SN is a Medical Research Council (MRC) Clinical Training Fellow supported by the North West England MRC Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the MRC (grant number G1000417/94909), ICON, GlaxoSmithKline, AstraZeneca and the Medical Evaluation Unit. SK is supported by the UK Higher Education Funding Council. AW is funded by the National Health Service, England. SL is supported by U.S. National Institute of Mental Health via K24 MH097673 and P30 MH62512. BDM is supported by a National Institute for Health Research (NIHR) Doctoral Research Fellow. JCM is supported by grants 5P30MH075673, UL1 RR 025005, and HHSN271201000036C from the National Institutes of Health, USA. TS is supported by NIHR Programme Grant RP-PG-0108-10048.
Publisher Copyright:
© 2014 Elsevier Ltd.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - 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.
AB - 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.
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U2 - 10.1016/S1474-4422(14)70137-1
DO - 10.1016/S1474-4422(14)70137-1
M3 - Review article
C2 - 25316020
AN - SCOPUS:84908006404
VL - 13
SP - 1139
EP - 1151
JO - The Lancet Neurology
JF - The Lancet Neurology
SN - 1474-4422
IS - 11
ER -