Evolving clinical phenotypes in HIV-associated neurocognitive disorders.

PURPOSE OF REVIEW: To describe the changes in the presentation of HIV-associated neurocognitive disorders (HAND) comparing the current combination antiretroviral therapy (cART) treatment era to the pre-cART era.

RECENT FINDINGS: The frequency of the most severe stage of HAND, HIV-associated dementia (HAD), has decreased, but the frequencies of milder stages of HAND, asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder, have increased. In the pre-cART era, HAD was a progressive disorder leading to death within months. With cART, HIV+ individuals with HAND frequently remain stable over many years, though they may still show signs of the ongoing central nervous system (CNS) injury. On neuropsychological testing, there may be a shift from the prominent slowed motor and speed of processing deficits in the pre-cART era to a greater impact on learning, memory, and executive functioning deficits in the cART era. Importantly, ANI has recently been shown to lead to a two-fold to five-fold increased progression to symptomatic HAND. Thus, early recognition and treatment of those with ANI is important to protect the CNS over the long term.

SUMMARY: HAND continues to be an important neurological manifestation in both HIV+ individuals naïve to cART and on cART.