Clinical Aspects of HIV‐Related Neurocognitive Disorders

This chapter discusses the epidemiology, clinical features, assessment, investigations and treatment of human immunodeficiency virus (HIV)-related neurocognitive disorders. In resource-rich settings, infection with HIV can be controlled with combined antiretroviral therapy (cART). Following the arrival of cART, the incidence and prevalence of cognitive impairment changed significantly amongst the HIV infected. In cART-treated patients, HIV-1-associated dementia (HAD) and mild neurocognitive disorder (MND), unfolds over a much longer time period, unless there is pan-resistance to antiretroviral (ARV) drugs. The chapter suggests an approach for the management of a HIV-associated neurocognitive disorders (HAND) patient. HIV patients with cognitive impairment should be screened for common metabolic causes of cognitive impairment and delirium including full blood count; vitamin B12 and red cell folate levels, and other parameters. HAND treatment at present is centred on ARV drugs. Eradication strategies need to address both access to the CNS cellular reservoir (astrocytes and microglia) whilst minimizing neural damage.