HIV-associated neurocognitive disorders.

Abstract

Since the first description of HIV and AIDS, it has been clear that cognitive impairment can be a common and early clinical feature of disease. Although anti-retroviral therapy has significantly reduced the frequency of HIV-associated dementia, mild cognitive impairment still affects up to 40 % of HIV-positive patients. However, the biological mechanisms underlying this clinical phenomenon remain poorly understood. A detailed understanding of the pathophysiology leading to HIV-associated neurocognitive disorders, and the temporal evolution of clinical manifestations of these deficits would be of great value in developing neuroprotective strategies. It would also be helpful in the early identification of patients with HIVassociated cognitive impairment, and allow the prompt use of targeted therapies. In this month’s journal club, we examine three recent papers investigating cognition and HIV. The first is a large, longitudinal study of men at risk of HIV which utilises novel statistical methods to model trajectory of cognitive decline over time and investigates the relative contribution of factors including HIV status, AIDS, depression and other comorbidities. The second paper is from a more recently established cohort of women with HIV, using a cross-sectional design to compare neuropsychological measures in HIV-positive and -negative women and assess the relative impact of HIV on cognition. The final paper is a study of CSF markers of neuronal degeneration and inflammation in patients with HIV-associated neurocognitive disorders, and may represent a promising early investigation of relevant biological mechanisms.