Neurocognitive disorders due to HIV infection

Among viruses that infect the brain, HIV-1 (human immunodeficiency virus type 1) is the most likely virus to cause dementia. Introduction of highly active antiretroviral therapy (HAART) increased the life expectancy of patients and decreased the number of patients developing dementia. However, reports suggest that HAART is associated with an increased incidence rate of minor cognitive and motor disorders. HIV affects the brain at an early stage of the infection process, and symptoms stem either directly from the HIV infection itself or indirectly from increased susceptibility to opportunistic infections. HIV-positive patients present with subcortical dementia, with neurological changes consisting in cognitive and motor dysfunctions. Diagnostic assessments require clinical examination, neuropsychological testing, laboratory explorations, and neuroimaging. The diagnosis and treatment of neurocognitive disorders due to HIV infection requires a multidisciplinary approach. Therapy for CNS infections remains a controversial issue. New efforts are underway to optimize both the penetration of antiretroviral therapies into CNS tissue and the effectiveness of adjuvant therapies designed to enhance intrinsic mechanisms of CNS repair and to protect neurons from further injury.