HIV Associated Neurocognitive Disorders in the Modern Antiviral Treatment Era: Prevalence, Characteristics, Biomarkers, and Effects of Treatment

The introduction of combination antiretroviral treatment (cART) has significantly reduced the mortality secondary to opportunistic infections in HIV patients by restoring the immune system. In the central nervous system (CNS), there has also been benefit with a marked reduction of HIV associated dementia. However, the milder forms of HIV associated neurocognitive disorder (HAND), namely asymptomatic neurocognitive impairment and mild neurocognitive disorder, remain prevalent in the cART era. In this article, we will discuss how cART interacts with HAND in terms of clinical characteristics and biomarkers. We will then review the outcomes of recent clinical studies focused on the CNS penetrating antiretroviral regimens and some novel therapeutic approaches.