The persistence of HIV-associated neurocognitive dysfunction and the effects of comorbidities

Despite the effectiveness of combination antiretroviral therapy (CART), many HIV-infected patients continue to experience cognitive problems.¹ The study by Heaton et al.² in this issue of Neurology® examined HIV-associated neurocognitive disorder (HAND) in a large national cohort from the multicenter CHARTER study, which assesses the changes in presentation of HIV neurologic complications in the modern era of HIV treatment. Only 2% of the cohort exhibited dementia, confirming clinical observations that severe functional decline is now relatively rare.¹ Yet 47% of the sample without major comorbidities met criteria for HAND. It is notable that the latter prevalence is similar to those reported in studies conducted before modern antiretroviral therapy.³ It is likely that this is partly attributable to the fact that HIV-infected patients are living longer with effective treatment, such that aging contributes to the prevalence of neurocognitive deficits. Nevertheless, the results provide clear evidence that HAND continues to be common despite the effectiveness of CART, and the prevalence of neurocognitive impairment is even greater when factoring in people with significant comorbidities commonly experienced by HIV-infected …