HIV-Associated Neurocognitive Disorders: The Relationship of HIV Infection with Physical and Social Comorbidities

Abstract

The prevalence of HIV (human immunodeficiency virus) associated neurocognitive disorders (HAND) will undoubtedly increase with the improved longevity of HIV-infected persons. HIV infection, itself, as well as multiple physiologic and psychosocial factors can contribute to cognitive impairment and neurologic complications. These comorbidities confound the diagnosis, assessment, and interventions for neurocognitive disorders. In this review, we discuss the role of several key comorbid factors that may contribute significantly to the development and progression of HIV-related neurocognitive impairment, as well as the current status of diagnostic strategies aimed at identifying HIV-infected individuals with impaired cognition and future research priorities and challenges.

Persistent HIV-infected cells in cerebrospinal fluid are associated with poorer neurocognitive performance

“…Mononuclear cells detected in CSF (lymphocytes, monocytes, of chronic immune activation and inflammation in HIV infection during ART could include immune changes and inflammation triggered in pre-ART HIV infection, chronic microbial translocation, effects of unrecognized coinfections, or viral persistence in tissues not accessed through the sampled fluids. Neurocognitive impairment in individuals with HIV is likely multifactorial, with potential contributions from a variety of etiologies including persistent HIV infection, age, unresolved neuro inflammation, and comorbid conditions such as substance use, vascular dysfunction, mood disorders, and poor educational attainment (35)(36)(37). Despite this, we identified a significant association between detectable HIV DNA in CSF cells and neurocognitive performance, revealing potential clinical relevance of this viral measure in the CNS.…”

Moderate to severe HIV-associated neurocognitive impairment

“…Fourth, cognitive assessment is influenced by HIV infection, physical -, psychiatric -, and social comorbidity. [21] We monitored HIV -, physical- and psychiatric comorbidities and did not detect an improvement, but it is plausible that we missed social comorbidity improvement explained by trial participation. Lastly, it is possible that only patients with certain covariates or characteristics (such as depression comorbidity) may respond significantly better to lithium compared with placebo.…”

<p>The Role of Brain Derived Neurotrophic Factor in HIV-Associated Neurocognitive Disorder: From the Bench-Top to the Bedside</p>

“…These factors include low literacy levels, limited access to healthcare, chronic exposure to trauma, poor dietary diversity, higher rates of treatment failure and late-onset of treatment. 114 There is also low clinical knowledge of the acute and chronic impact of antiretroviral therapy on BDNF expression. Results of such studies coupled with BDNFmodulatory adjunctive medication for co-morbid disorders and as well BDNF-inspired non-pharmacological interventions can feed into designing personalized treatment for people living with HIV with neurocognitive impairment.…”