HIV is neurovirulent and a substantial proportion of HIV-infected people not receiving highly active antiretroviral therapy (HAART) demonstrate clinically relevant central nervous system (CNS) symptoms.1
HAND encompasses a spectrum of neurocognitive effects that may be associated with HIV infection. These can be classified into the following categories, and in each case there should be no evidence of another (non-HIV) pre-existing cause:7
While HAART has reduced the incidence of HAD in developed countries, the prevalence of ANI and MND appear to be rising as patient survival increases.8
|Entry/fusion inhibitors||maraviroc (MRV)||enfuvirtide (ENF)|
|Integrase inhibitors||raltegravir (RAL)|
Created from: McArthur J, Steiner J, et al. Ann Neurol. 2010;67:699–714; Antinori A, Arendt G, et al. Neurology. 2007; 69: 1789–1799
1. Valcour V, Sithinamsuwan P, Letendre S, et al. Pathogenesis of HIV in the central nervous system. Curr HIV/AIDS Rep. 2011; 8:54–61.
2. Heaton RK, Franklin DR, Ellis RJ, et al.HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011; 17:3–16.
3. Simioni S, Cavassini M, Annoni JM, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010; 24:1243–1250.
4. Heaton RK, Velin RA, McCutchan JA, et al. Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. HNRC Group. HIV Neurobehavioral Research Center. Psychosom Med. 1994; 56:8–17.
5. Woods SP, Moran LM, Carey CL, et al.Prospective memory in HIV infection: is "remembering to remember" a unique predictor of self-reported medication management? Arch Clin Neuropsychol. 2008; 23:257–270.
6. Sevigny JJ, Albert SM, McDermott MP, et al.An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection. Arch Neurol. 2007; 64:97–102.
7. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007; 69:1789–1799.
Singh D. Neurocognitive Impairment In PLWHA: Clinical Features And Assessment. Southern African Journal of HIV Medicine. 2009; 10(3):30–34.