, Volume 73, Issue 9, pp 893–905 | Cite as

HIV-Associated Neurocognitive Disorders: Perspective on Management Strategies

  • Linda Nabha
  • Lan Duong
  • Joseph TimponeEmail author
Therapy in Practice


Potent combination antiretroviral therapy (ART) has resulted in dramatic improvements in AIDS-associated morbidity and mortality. Although combination ART has resulted in a significant reduction in HIV-associated dementia, the most severe of the HIV-associated neurocognitive disorders (HAND), the overall prevalence of HAND among this population is estimated at 40 %. It has been recognized that the central nervous system (CNS) serves as a reservoir for HIV, and neuronal damage begins at the time of acute infection and persists due to chronic infection of microglial and perivascular macrophages. Although combination ART has resulted in virologic control in the plasma compartment, virologic breakthrough can potentially ensue within the CNS compartment due to limited ART drug exposure. The purpose of this review is to discuss the definition, clinical spectrum, and risk factors associated with HAND, review the pathogenesis of HAND, and address the pharmacologic challenges associated with ART drug exposure in the CNS compartment.


Human Immunodeficiency Virus Atazanavir Human Immunodeficiency Virus Patient Darunavir Maraviroc 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of MedicineGeorgetown University HospitalWashington, DCUSA
  2. 2.Department of PharmacyGeorgetown University HospitalWashington, DCUSA

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