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Cognitive Impairment and Persistent CNS Injury in Treated HIV

  • Complications of Antiretroviral Therapy (G McComsey, Section Editor)
  • Published:
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Abstract

The implementation of combination antiretroviral therapy (cART) has changed HIV infection into a chronic illness, conveying extensive benefits, including greater longevity and advantages for the central nervous system (CNS). However, studies increasingly confirm that the CNS gains are incomplete, with reports of persistent immune activation affecting the CNS despite suppression of plasma HIV RNA. The rate of cognitive impairment is unchanged, although severity is generally milder than in the pre-cART era. In this review, we discuss cognitive outcomes from recently published clinical HIV studies, review observations on HIV biomarkers for cognitive change, and emphasize longitudinal imaging findings. Additionally, we summarize recent studies on CNS viral invasion, CD8 encephalitis, and how CNS involvement during the earliest stages of infection may set the stage for later cognitive manifestations.

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Acknowledgments

This work is supported by K24-MH098759 (VV) and R01MH095613 (VV and SS). Dr. Chan is supported by funds from the National Institutes of Mental Health, US NIH T32AG023481.

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Authors and Affiliations

  1. SEARCH-Thailand, Thai Red Cross AIDS Research Center, Bangkok, Thailand

    Phillip Chan

  2. Memory and Aging Center, MC: 1207, Sandler Neurosciences Building, 675 Nelson Rising Lane, Room 192C, Department of Neurology, University of California San Francisco, San Francisco, CA, 94143-1207, USA

    Joanna Hellmuth & Victor Valcour

  3. Department of Neurology, Yale University, New Haven, CT, USA

    Serena Spudich

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  1. Phillip Chan
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Correspondence to Victor Valcour.

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Phillip Chan reports grants from National Institute of Health (NIH): National Institute of Mental Health (NIMH) T32AG023481.

Joanna Hellmuth declares she has no conflict of interest.

Serena Spudich reports grants from National Institute of Health (NIH): National Institute of Mental Health (NIMH) and National Institute of Neurological Disorders and Stroke (NINDS).

Victor Valcour reports grants from National Institute of Health (NIH): National Institute of Mental Health (NIMH) and National Institute of Neurological Disorders and Stroke (NINDS) and consultant fees from ViiV Healthcare and Merck.

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Chan, P., Hellmuth, J., Spudich, S. et al. Cognitive Impairment and Persistent CNS Injury in Treated HIV. Curr HIV/AIDS Rep 13, 209–217 (2016). https://doi.org/10.1007/s11904-016-0319-7

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