Vol.68 No.1 January 2020
Current understanding of HIV-associated neurocognitive disorder
Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami, Okinawa, Japan
Abstract
An HIV-associated neurocognitive disorder (HAND) is a cognitive impairment associated with HIV infection. Based on neuropsychological test performance and concomitant impairment in activities of daily living, HAND sub-classifications are classified as asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD), which is the most severe form. HAND is reported to have a 20-74% prevalence rate.
Since the introduction of combination antiretroviral therapy (cART), HAND has dramatically decreased. However, the prevalence of ANI and MND continues to increase, and that is a new problem for which the cause is not yet clear. Most patients who develop HAND not only have difficulty performing social activities, but also may have reduced medication adherence. Based on these results, there is the possibility of drug-resistance for HIV emerging, and a significantly detrimental effect on prognosis.
According to previous studies, HIV easily disseminates to the central nervous system (CNS) shortly after infection and is thought to infect macrophage (Mφ) and glial cells, but not neurons. Chronic inflammation and neurotoxic substances in the CNS cause serious damage to the neural network. From a clinical and neuropsychological point of view, the pathology of HAND can be explained as frontal lobe-subcortical cognitive impairment. Regular dementia screening tests cannot detect cognitive decline in HAND. Therefore, it is necessary to diagnose with a battery that combines multiple neuropsychological examinations by experts in neuropsychology. The optimal penetration into the CNS, supported by CPE scores, is taken into consideration when selecting the treatment regimen for HAND.
How to effectively manage patients with HAND who are at risk of lowering ART adherence is important for the suppression of AIDS epidemics and poses new challenges.
Received
January 21, 2019
Accepted
July 30, 2019
Jpn. J. Chemother. 68 (1): 108-115, 2020
