The Impact of Pre-Combination Antiretroviral Therapy versus Combination Antiretroviral Therapy Era on HIV-associated Neurocognitive Disorders: A Systematic Review

Objectives The objective of this presentation is a systematic literature review to consider HIV-associated neurocognitive disorder (HAND) rates before and during the cART era. Background This paper is a combination of literature reviews, observational studies, prospective studies and retrospective studies. A second objective of this systematic review is to identify and summarize recent studies that examine asymptomatic neurocognitive impairment in HAND during the pre-combination Antiretroviral Therapy (pre-cART) and combination Antiretroviral Therapy (cART) era. Methods A systematic literature review was conducted to include English-language articles published from 2006 to 2016 on January 19th, 2017. A total of four electronic databases were used including MEDLINE, PUBMED, EMBASE, and PsycINFO and were searched to identify potentially relevant articles. Conference abstracts and dissertation defenses were not included in this review. The search combined free text and medical subject headings (MeSH) disease terms with HIV-associated neurocognitive AND combination antiretroviral therapy with asymptotic neurocognitive impairment OR mild cognitive disorder OR HIV-associated dementia Results Despite enhanced research efforts and effective cART, there still is a high prevalence of HAND within the HIV-infected population. Although the most severe form of HAND, HIV associated dementia (HAD) is much less common in cART era, researchers still pose questions about any long-term benefit of cART with respect to milder forms of HAND. Preliminary findings have shown that patients with ANI will progress more quickly to more severe forms of HAND than those without ANI. Given this, the relevance of the correct diagnosis of ANI is crucial where well over 50% of all HIV-infected patients suffer from some stage of HAND mentioned above. Conclusions There are various social, economic, and public health implications surrounding HIV & neurocognitive disorders. The burden of disease for this population is increasing at an exponential rate but are still unaware of the long-term survival with chronic immune activation. Future studies should assess the will this impact the aging population, the role of medication adherence, the impact of comorbidities affect HIV-associated neurocognitive disorders and the role of poly-pharmacy. Overall there is a continued need for biomarkers of HAND predisposition, detection, and monitorin