Troubles cognitifs associés à l'infection VIH

Today, thanks to cART, the brain of HIV-infected-patients is front of the chronic infection from a neurotropic virus. The ageing of this infected population is associated with accumulation of comorbid-conditions presenting a potential synergic interaction with HIV, at a systemic but also central level. HIV associated neurocognitive disorders have a frontal sub-cortical expression. Clinical profile of HIV-infected-patients can be modified by the evolution of the disease over the time but also by modifications of definition criteria. Indeed, since few years, we are in a new model with, for example, an asymptomatic stage specific for HIV-infected-people or different cut-off than these used and validated in general population. In this context, we consider that 30 to 50% of HIV-infected-patients would have neuro-cognitive disorders while questions of minor disorders screening and prognostic value of prodromal stages remain controversial. In the daily clinical care, the logistic question is acute in front of this complex, the most of time multifactorial and proteiform disease witch needs a systematic multidisciplinary management. In fact, if neuro-cognitive test is essential for the diagnosis, the management must stay global, focused on the optimal control of comorbid conditions, and not exclusively on the supposed capacity of ART to reach CNS through the blood-brain barrier.