Effective combination antiretroviral therapy (cART) has lead to a significant reduction in the prevalence and incidence of central nervous system (CNS) HIV-associated brain disease, particularly CNS opportunistic infections and HIV encephalitis. Despite this, cognitive deficits in people living with HIV, also known as HIV-associated neurocognitive disorders (HAND) have become more prevalent in recent years. The pathogenesis of HAND is likely to be multifactorial, however recent evidence suggests that brain microglial activation is the most likely pathogenic mechanism. Recent developments in positron emission tomography (PET) brain neuroimaging using novel brain radioligands targeting a variety of physiological changes in the brains of HIV-positive individuals have improved our understanding of the mechanisms associated with the development of HAND. This review will highlight recent PET brain neuroimaging studies in the cART era, focusing on physiological and neurochemical changes associated with HAND in people living with HIV.

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intensive quit-smoking support as treatment for their disease. The aim of this study was to assess the efficacy of standard quit-smoking interventions (NICE, 2008) for COPD-smokers, to determine levels of support required to improve quit rates. Methods Current smokers with confirmed COPD were referred from within an inner-city general hospital (inpatients/outpatients) to a dedicated quit-smoking specialist (QSS) or from the community COPD-multidisciplinary team to an integrated QSS, who undertook domiciliary visits for housebound smokers. Both QSS had additional counselling skills. Demographics, disease severity (FEV 1 ), smoking history, duration of quit-smoking treatment, pharmacotherapy and quits (4 week) were prospectively recorded over 11 months (September 2010eJuly 2011. Results 106 patients with moderate COPD M:F 39:67, mean6SD age 66.4610.4 y range 49e85; FEV 1 1.260.6l, n¼76) were referred: 63 (69%) hospital patients (HP), 43 (41%) from the community (CP). Compared to the HP who had mean6SD FEV 1 1.460.5 l, and smoked 23.5611.4 cigarettes/day on referral, CP had significantly (p¼0.03) worse lung function (FEV 1 1.260.5 l) but smoked fewer (p¼0.002) cigarettes/day (9.868/day). 25/106 (24%) patients quit, but quits were significantly lower (p<0.05) in the CP (20%) compared to the HP (30%). 45/106 (42%) were not able to set a quitdate, 5/106 (5%) set multiple quit-dates. 56/106 (53%) used nicotine replacement therapy (NRT), >2 products in 48/56. 18/106 (17%) used varenicline, seven sequentially following NRT. Duration of pharmacotherapy for quitters was 6.164.5 months (mean6SD, range 1e16). 38/106 (36%) were discharged after lost to follow-up. Conclusions These data demonstrate that 1-in-4 smokers with COPD are able to quit using evidence based tobacco addiction treatment. However, quit rates for these smokers are much lower than the Department of Health (DH) expectation of >35%, despite intensive interventions by skilled QSS, domiciliary visits to housebound patients, and pharmacotherapy extended beyond the standard 8e12 weeks. Novel approaches, including addressing psychosocial issues, motivational quit-date setting, review of the DH 4-week quit-target and sufficient funding for extended NRT/ Varenicline prescribing, may be required to achieve effective smoking cessation in this patient group. Introduction and Aim A Cochrane review concluded that there is a lack of evidence to support lung function and lung age measures as a method for increasing smoking cessation quit rates. This study aims to assess whether providing lung health checks in workplaces and community settings, combined with immediate access to high quality smoking cessation advice, will promote behaviour change in smokers. Method The intervention consisted of spirometry followed by a detailed and personalised explanation of the findings. The results were delivered in plain non-clinical language, using lung age, visual tools and local analogies. The results were augmented by a written report and advice with regard to any action indicated. ...

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