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Open Access 01-08-2017 | Review

HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment

Authors: Christian Eggers, Gabriele Arendt, Katrin Hahn, Ingo W. Husstedt, Matthias Maschke, Eva Neuen-Jacob, Mark Obermann, Thorsten Rosenkranz, Eva Schielke, Elmar Straube, For the German Association of Neuro-AIDS und Neuro-Infectiology (DGNANI)

Published in: Journal of Neurology | Issue 8/2017

Abstract

The modern antiretroviral treatment of human immunodeficiency virus (HIV-1) infection has considerably lowered the incidence of opportunistic infections. With the exception of the most severe dementia manifestations, the incidence and prevalence of HIV-associated neurocognitive disorders (HAND) have not decreased, and HAND continues to be relevant in daily clinical practice. Now, HAND occurs in earlier stages of HIV infection, and the clinical course differs from that before the widespread use of combination antiretroviral treatment (cART). The predominant clinical feature is a subcortical dementia with deficits in the domains concentration, attention, and memory. Motor signs such as gait disturbance and impaired manual dexterity have become less prominent. Prior to the advent of cART, the cerebral dysfunction could at least partially be explained by the viral load and by virus-associated histopathological findings. In subjects where cART has led to undetectable or at least very low viral load, the pathogenic virus–brain interaction is less direct, and an array of poorly understood immunological and probably toxic phenomena are discussed. This paper gives an overview of the current concepts in the field of HAND and provides suggestions for the diagnostic and therapeutic management.

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Title: HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment
Authors: Christian Eggers
Gabriele Arendt
Katrin Hahn
Ingo W. Husstedt
Matthias Maschke
Eva Neuen-Jacob
Mark Obermann
Thorsten Rosenkranz
Eva Schielke
Elmar Straube
For the German Association of Neuro-AIDS und Neuro-Infectiology (DGNANI)
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 8/2017
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-017-8503-2

At a glance: The STEP trials

Springer Medicine

HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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