Neurocognitive disorders during antiretroviral treatment, despite full HIV RNA suppression

Abstract

After the introduction of HAART in the late 1990s, there were dramatic reductions in HIVrelated neurological disorders such as dementia, CNS lymphoma and cerebral toxoplasmosis [1]. However, minor neurocognitive disorders are still detected in a high proportion of patients receiving antiretrovirals, even if HIV RNA levels are suppressed below 50 copies/ml in plasma [2,3]. HIV-associated neurocognitive disorders are defined by asymptomatic neurocognitive impairment, minor neurocognitive disorders and HIV-associated dementia. These disorders are identified either by clinical diagnosis and/or neurocognitive testing. In some studies, samples of cerebrospinal fluid (CSF) have been tested for HIV RNA and plasma PK levels of antiretrovirals. There is a background incidence of neurological disorders in the general population [4,5], and there may be other confounding factors such as recreational drug use, psychiatric illness, a lcohol abuse/use and hepatitis B or C infection [6].