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HIV-Associated Cognitive-Motor Disorders

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Cognitive-motor disorders in patients with HIV infection are common and may be progressive (25, 26). However, the incidence of HIV-associated dementia in the CART era has been reduced by 50%, and a similar reduction has been reported for minor cognitive-motor disorder. It is not yet clear whether this benefit persists over the long-term course of illness and treatment or which regimens are most effective in sustaining cognitive function. In developed countries, it has been suggested that the prevalence of cognitive disorders has increased because of the increased longevity of the patient population overall. It can be concluded that these disorders continue to be a significant source of morbidity among patients (25, 27, 28).

In many HIV patients with neurocognitive impairment, the impairment probably remains undiagnosed. Patients with HIV-associated cognitive-motor disorder may benefit from early intervention with combination antiretroviral therapy, as well as adjuvant treatments for the pathophysiological factors in the CNS that contribute to neurocognitive impairment. Available antiretroviral agents suppress HIV replication but do not eradicate the virus. The brain can serve as an important reservoir for the virus, contributing to an increased likelihood that a cognitive-motor disorder may develop over time.

Some antiretroviral agents can cross the blood-brain barrier and therefore decrease viral load in the cerebrospinal fluid. Improvements in neurocognitive function, however, have been shown even with regimens not containing cerebrospinal fluid (CSF)–penetrating antiretrovirals. In a study of 31 patients who received new antiretroviral treatment, patients whose regimens included CSF-penetrating agents showed greater reduction in CSF viral load and improved neuropsychological function. Treatment-naive patients had greater improvement in neuropsychological function than treatment-experienced patients (29). Other studies have not shown benefit, and thus the question of whether adding CSF-penetrating agents is beneficial is still controversial. Other immunological factors (i.e., chemokines, cytokines, tumor necrosis factor) are also implicated in the development of neuropathological changes leading to neurocognitive symptoms. Other factors that contribute to progression of cognitive disorders include age, concurrent methamphetamine use, and hepatitis coinfection (29–32).

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