Cognitive Impairment in people living with HIV in the ART era: A Review

Background: Cognitive disorders are a common issue impacting those living with human immunodeficiency virus (HIV). Effective antiretroviral treatment has lessened the severity but not the frequency of these impairments. Such deficits reduce quality of life and present a significant challenge to clinicians in the context of an ageing HIV population with a growing number of comorbidities. Sources of data: This review is based on recent published literature in the field of HIV-associated cognitive impairment (HAND). Areas of agreement: The pathogenesis of HAND is multifactorial and can be categorized into HIV viral factors, antiretroviral factors and individual factors. The risk factors associated with HAND are well documented. Areas of controversy: The prevalence of HAND in HIV populations varies and is dependent on populations studied and assessment batteries used. Disease progression is poorly understood and has important implication for screening programmes. The relative contribution of pathogenic mechanisms causing HAND is unclear, but recent papers point to inflammation as a significant contributor. Growing areas: The role of psychiatric diseases, such as depression, in the development and maintenance of HAND has recently been examined and requires clinical consideration. Furthermore, as the HIV population ages, its clinical management faces new challenges. Areas timely for developing research: Identifying biomarkers for HAND which are practical in a clinical setting and utilizing new imaging technologies to better monitor diagnosis and disease progression. Furthermore, the development of therapeutics targeting inflammation appears of increasing importance.