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Since the introduction of highly active antiretroviral therapy in 1996, the epidemiologic profile of HIV-associated neurocognitive disorder (HAND) has shifted drastically. Although HIV-associated dementia has nearly disappeared from clinical practice, presymptomatic and milder variants of HAND affect up to 50% of patients on chronic antiretroviral therapy.1,2 Furthermore, the predominant phenotype has evolved from a subcortical dementia to a mixed cortical-subcortical cognitive syndrome affecting attention, executive, and memory systems, as well as slowing processing speed.2 Yet, subtler forms of HAND often remain undetected. One Swedish HIV study found that only 27% of their patient cohort complained of cognitive dysfunction, but 67% actually demonstrated objective deficits on cognitive testing.3
ACKNOWLEDGMENT
The authors acknowledge Michael D. Fox, MD, PhD, and Michael Gregory, MD, for their insightful contributions regarding rs-fcMRI techniques.
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 1186
- © 2013 American Academy of Neurology
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