Update 1 – The effectiveness and access of HIV-associated neurocognitive disorder treatments

In an effort to better understand and critique the current effectiveness and access of treatments for HIV-associated neurocognitive disorder (HAND), I first focused my research on what exactly this disorder entails. I broke the topic into smaller categories, reviewing scientific journals to learn about the many factors and components of HIV-associated dementia.

I started with the question, “What is HAND?” I took notes from published literature reviews on the topic to obtain a broad understanding of the disease’s prevalence, classifications, and symptoms. HAND is one type of neuroAIDS, the other being opportunistic infections. It occurs in as many as 50% of individuals with HIV and causes impairments in many different cognitive domains, including memory, executive function, and psychomotor speed.

I then investigated, “How does HAND occur?” I read significantly more literature for this subtopic, because the pathogenesis of the disorder has no one clear explanation. Rather, a number of factors, including transmigration across the blood brain barrier, macrophage and microglial activation, and cytokine production all contribute to the cognitive deficits we see in many HIV+ patients.

Closely related to this subtopic were two of my other questions: “What are the risk factors for HAND?” and “What biomarkers are used to predict and track HAND?” Factors such as older age, vascular disease, and Hepatitis C make individuals more likely to experience cognitive impairment. While researching biomarkers, I learned that measuring HIV RNA in the cerebrospinal fluid is one way to track the progression of the disease, but many other methods have been, and continue to be, developed and assessed.

Once I had a deeper understanding of how HAND occurs, I then began researching the current treatments being used to relieve symptoms and stop disease progression. Combination antiretroviral therapy (cART), which has been used to treat AIDS since the mid 1990s, has been extensively studied for its impact on HAND. This treatment has had such a large impact on the fight against AIDS that literature refers to pre- and post-cART eras, asking “How effective is cART  as a treatment for HAND?” Though there has been decrease in the prevalence of extreme dementia in HIV+ individuals, a large percentage still experience lower level cognitive impairment that neither improves nor worsens over their lifetime. For this reason, studies continue to investigate how cART can be used decrease the effective of HAND on daily functioning and what other forms of treatment, such as computer based cognitive training, could do this as well.

Because HIV/AIDS has its most devastating impact in less developed countries, I made sure to research, “How accessible are HAND treatments in resource-limited settings?” Though efforts are being made to make cART affordable and obtainable in other parts of the world, groups such as The World Health Organization have outlined the many gaps in the system and, most importantly, how we might go about filling them.

My final product will be a literature review that covers these HAND topics, so my next step in the research process is to organize the notes I have collected from over forty sources and use them to create an outline that will help me begin drafting my paper.

Comments

  1. lgkohout says:

    This is a very interesting topic that you are looking into the literature for! I have not heard of neuroAIDS before, nor was I aware that HIV could cause cognitive impairments. In high school, I watched a film on the AIDS outbreak in California. The history of this disease is a very interesting one, and I am happy to see you mention some of that history your blog post.

    I find it interesting that cART has been used since the 1990s. It is surprising that we are still using a medical treatment from the 90s. I feel that technology has advanced so much since then. Are you aware of any updates/changes at all to this treatment? Do you think this old treatment may be a concern for patients?

    I am glad the WHO is working to make the treatment for neuroAIDS more accessible in less developed countries. This is especially important, as you mention, because AIDS is most devastating in areas of lesser development. It is great that the WHO addressed, or at least posted a report about, the holes in coverage for cART. I think it would be really interesting to try to find a cost/benefit analysis of cART and include ways to improve the cost without sacrificing the effectiveness of the treatment… This is another reason why I am surprised another treatment, or at least a variation of the treatment, has not been developed. Even if a new treatment is not necessary, there is still room for improvement especially with the cost and accessibility. I believe cART should continue to be researched and changed in order to make it (or a version of it) more available to less developed countries. What are your thoughts about the cART treatment?

    I am looking forward to reading your literature review. Keep up the great work!

  2. mbcmgill says:

    Hi,
    Thanks for you interest! I do agree that it is surprising that we are using the same treatment, when for many other diseases we switch to entirely new methods over the years. However, improvements continue to be made with cART, and it consists of over 25 drugs that are continually being added to and updated. cART treatment is usually comprised of three drugs, and this combination is often changed depending on the patient. Some concerns include drug-drug interaction and adherence rates, which is why individual regimens can be altered over time.

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