Table 1.

CNS penetration-effectiveness scores of antiretroviral agents.

Table 2.

Review of studies that have assessed the efficacy of neuroprotective drugs.

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■ Proposes a practical method to measure cART efficacy in the CNS.
Cysique LA, Vaida F, Letendre S et al.: Dynamics of cognitive change in impaired HIV-positive patients initiating antiretroviral therapy. Neurology 73(5), 342-348 (2009).
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Papers of special note have been highlighted as:
■ of interest
■■ of considerable interest

CME

HIV-Associated Neurocognitive Disorders: A Changing Pattern

Authors: Samanta Simioni, MD; Matthias Cavassini, MD; Jean-Marie Annoni, MD; Bernard Hirschel, MD; Renaud A. Du Pasquier, MD
CME Released: 12/21/2010
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 12/21/2011

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care clinicians, infectious disease experts, neurologists, psychiatrists, and other health professionals caring for patients with HANDs.

The goal of this activity is to review the epidemiology, pathophysiology, and management of HANDs.

Upon completion of this activity, participants will be able to:

Describe changes in the epidemiology of HIV-associated dementia and HANDs
Describe the pathophysiology underlying HANDs
Describe the management of patients with HANDs and clinical trials on neuroprotective agents

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Author(s)

Samanta Simioni, MD

Division of Neurology, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Disclosures

Disclosure: Samanta Simioni, MD, has disclosed no relevant financial relationships.

Matthias Cavassini, MD

Division of Infectious Diseases, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Disclosures

Disclosure: Matthias Cavassini, MD, has disclosed no relevant financial relationships.

Jean-Marie Annoni, MD

Division of Neurology, Geneva University Hospital, Geneva, Switzerland

Disclosures

Disclosure: Jean-Marie Annoni, MD, has disclosed no relevant financial relationships.

Bernard Hirschel, MD

Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospital, Geneva, Switzerland

Disclosures

Disclosure: Bernard Hirschel, MD, has disclosed no relevant financial relationships.

Renaud A. Du Pasquier, MD

Division of Neurology, Department of Immunology, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Disclosures

Disclosure: Renaud A. Du Pasquier, MD, has disclosed that this work was supported by a grant from the Swiss HIV Cohort Study (No 514) and by the SNF PP00P3-124893.

Editor(s)

Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

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Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

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Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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From Future Neurology

CME

HIV-Associated Neurocognitive Disorders: A Changing Pattern

Authors: Samanta Simioni, MD; Matthias Cavassini, MD; Jean-Marie Annoni, MD; Bernard Hirschel, MD; Renaud A. Du Pasquier, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 12/21/2010

Valid for credit through: 12/21/2011

processing....

Abstract and Introduction

Abstract

Combination antiretroviral therapy has dramatically decreased the incidence of HIV-related mortality and serious opportunistic diseases, among which is HIV-associated dementia. However, minor forms of cognitive dysfunction have not disappeared and may even have increased in frequency. Aging of HIV+ patients, insufficient penetration of antiretroviral drugs into the brain with continuous low-grade viral production and inflammation may play a role. A putative neurotoxicity of combination antiretroviral therapy is controversial. In this article, we will discuss these aspects, as well as clinical and pathophysiological features shared by HIV-associated neurocognitive disorders and other neurodegenerative diseases, especially Alzheimer's disease. This article will briefly summarize the current clinical trials on neuroprotective agents, and the management of patients with neurocognitive disorders will be discussed.

Introduction

The survival prognosis of HIV infection has dramatically improved in western countries thanks to the introduction of combination antiretroviral therapy (cART). Moreover, the incidence of the classical neurological complications of HIV (e.g., cryptococcal meningitis, cerebral toxoplasmosis, progressive multifocal leuko-encephalopathy or primary CNS lymphoma) has also decreased.^[1] Nevertheless, despite these notable improvements in immune outcomes, HIV-associated neurocognitive disorders (HANDs) still remain an important issue.

The aim of this article is to discuss the causes and pathogenic mechanisms of the persistence of HANDs in cART-treated patients in order to provide an update on possible therapies and to propose an algorithm for the management of HIV-infected patients susceptible to developing HANDs.

Page 1 of 9

Modification of the Spectrum of Cognitive Disorders in HIV-infected Patients

CME Information

References

Table 1.

Table 2.

References

Faculty and Disclosures

Author(s)

Samanta Simioni, MD

Matthias Cavassini, MD

Jean-Marie Annoni, MD

Bernard Hirschel, MD

Renaud A. Du Pasquier, MD

Editor(s)

Elisa Manzotti

CME Author(s)

Laurie Barclay, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

CME

HIV-Associated Neurocognitive Disorders: A Changing Pattern

Target Audience and Goal Statement

Disclosures

Author(s)

Samanta Simioni, MD

Matthias Cavassini, MD

Jean-Marie Annoni, MD

Bernard Hirschel, MD

Renaud A. Du Pasquier, MD

Editor(s)

Elisa Manzotti

CME Author(s)

Laurie Barclay, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

HIV-Associated Neurocognitive Disorders: A Changing Pattern

Abstract and Introduction

Abstract

Introduction

Table of Contents