The Persistence of HIV-Associated Neurocognitive Disorder (HAND) in the Era of Combined Antiretroviral Therapy (cART)

Author(s):  
Elyse J. Singer ◽  
Natasha M. Nemanim
AIDS ◽  
2016 ◽  
Vol 30 (4) ◽  
pp. 591-600 ◽  
Author(s):  
Thomas M. Gates ◽  
Lucette A. Cysique ◽  
Krista J. Siefried ◽  
Joga Chaganti ◽  
Kirsten J. Moffat ◽  
...  

Author(s):  
Musheer Ahmed ◽  
Ashif Iqubal ◽  
Sanjula Baboota ◽  
Javed Ali

: With the introduction of antiretroviral therapy, the worldwide AIDS-related deaths have decreased, and life expectancy has increased, so has the prevalence of AIDS-related neurological disorders or neuroAIDS. HIV associated neurocognitive disorder such as mild neurocognitive disorder and asymptomatic neurocognitive impairment have largely remained stable or increased among the HIV infected individuals in the combination antiretroviral therapy era and with the emerging evidence that antiretrovirals with high CNS penetration effectiveness score contribute to the neurotoxicity and HIV associated neurocognitive disorder. have ushered the search for natural, nontoxic bioactive constituents having pre-established neuroprotective, anti-inflammatory and restorative neurocognitive activity. In this review, we have highlighted the probable mechanism of neuroAIDS infection, the problem with the existing antiretroviral therapy, along with various bioactive constituents with in vivo, in vitro, or ex vivo evidence of their neuroprotective activity that can be used as an adjuvant with the current combination antiretroviral therapy regimen or can even serve as an alternate to the antiretrovirals for treatment of HIV associated neurocognitive disorder.


Author(s):  
Joshua Alexander ◽  
David J Croteau ◽  
Ronald J Ellis

Three subclassifications of HIV Associated Neurocognitive Disorders (HAND) can be delineated: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). HAND occurs in about half of patients infected with HIV. All forms, including ANI and MND, are associated with unemployment and reduced antiretroviral adherence, which can lead to loss of virologic suppression, further neurocognitive decline, and systemic illness. Fortunately, combined antiretroviral therapy can stabilize and even reverse cognitive impairment.


2019 ◽  
Vol 81 (2) ◽  
pp. 216-223 ◽  
Author(s):  
Ned Sacktor ◽  
Deanna Saylor ◽  
Gertrude Nakigozi ◽  
Noeline Nakasujja ◽  
Kevin Robertson ◽  
...  

Author(s):  
Ahmed Abd Elkader Elrashedy

In the last two decades, several advancement studies have increased the care of HIV-infected individuals. Specifically, the development for preparation of combination antiretroviral therapy has resulted in a dramatic decline in the rate of deaths from AIDS. The term “HIV-associated neurocognitive disorder” (HAND) has been used to distinguish the spectrum of neurocognitive dysfunction associated with HIV infection. HIV can pass to the CNS during the early stages of infection and last in the CNS. CNS inflammation and infection lead to the development of HAND. The brain can serve as a sanctuary for ongoing HIV replication, even when the systemic viral suppression has been achieved. HAND can remain in patients treated with combination antiretroviral therapy, and its effect on survival, quality of life, and everyday functioning make it a significant unresolved problem. This chapter discusses details of the computational modeling studies on mechanisms and structures of human dopamine transporter (hDAT) and its interaction with HIV-1 trans activator of transcription (Tat).


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joseph Bryant ◽  
Sanketh Andhavarapu ◽  
Christopher Bever ◽  
Poornachander Guda ◽  
Akhil Katuri ◽  
...  

AbstractThe combined antiretroviral therapy era has significantly increased the lifespan of people with HIV (PWH), turning a fatal disease to a chronic one. However, this lower but persistent level of HIV infection increases the susceptibility of HIV-associated neurocognitive disorder (HAND). Therefore, research is currently seeking improved treatment for this complication of HIV. In PWH, low levels of brain derived neurotrophic factor (BDNF) has been associated with worse neurocognitive impairment. Hence, BDNF administration has been gaining relevance as a possible adjunct therapy for HAND. However, systemic administration of BDNF is impractical because of poor pharmacological profile. Therefore, we investigated the neuroprotective effects of BDNF-mimicking 7,8 dihydroxyflavone (DHF), a bioactive high-affinity TrkB agonist, in the memory-involved hippocampus and brain cortex of Tg26 mice, a murine model for HAND. In these brain regions, we observed astrogliosis, increased expression of chemokine HIV-1 coreceptors CXCR4 and CCR5, neuroinflammation, and mitochondrial damage. Hippocampi and cortices of DHF treated mice exhibited a reversal of these pathological changes, suggesting the therapeutic potential of DHF in HAND. Moreover, our data indicates that DHF increases the phosphorylation of TrkB, providing new insights about the role of the TrkB–Akt–NFkB signaling pathway in mediating these pathological hallmarks. These findings guide future research as DHF shows promise as a TrkB agonist treatment for HAND patients in adjunction to the current antiviral therapies.


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