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

Eighty hours later, I have completed my Freshman Monroe Summer Research project. My final product comes in the form of a literature review of HIV-associated cognitive disorder (HAND) research and treatments. Our knowledge of HIV infection in the brain and how it causes HAND has increased significantly over the past twenty years. Understanding of HAND’s pathogenesis, risk factors, comorbidities, and biomarkers is crucial to the development and assessment of combination antiretroviral therapies (cART). Though cART has become commonplace in developed countries like the U.S., many issues still need to be resolved before this treatment is considered fully effective against HAND. Specifically, poor BBB penetration leads to incomplete viral suppression and drives neurodegeneration. Neural damage can also occur due to prolonged exposure to inflammatory responses. Additional problems include drug resistance, drug-drug interactions, adverse effects, comorbidities, and adherence. Recent research suggests the importance of early cART initiation, so this has become another area of focus. This is especially true in resource-limited settings, where late initiation contributes to lower cART efficacy. Groups like the World Health Organization outline strategies for successful large-scale cART initiation, taking into consideration the specific challenges that under-developed countries face. Scientists, doctors, and humanitarians alike work to improve cART, make it more effective against HAND, and increase access across all global settings. While cART is the main HIV and HAND treatment and therefore the most researched, adjuvant therapies like Minocycline and cognitive rehabilitation techniques such as transcranial direct stimulation are also being explored. The research conducted over the past twenty years on HIV and how it impacts the brain has informed our current treatment strategies. However, this work will only be complete once cART, or some other treatment, is fully effective against HAND for all HIV+ individuals.

Update 2 – The effectiveness and access of HIV-associated neurocognitive disorder treatments

This past week of research has been very exciting, as I was really able to see my final project, a literature review, begin to come together. After spending a large portion of my research hours collecting information from nearly forty scientific journals (see my previous post for more details), I was able to organize and synthesize all of this information in the form of an outline.

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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.

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

HIV is a worldwide issue, and as many as half of HIV patients experience some form of cognitive impairment as a result. HIV-associated neurocognitive deficits can range from minor impairment to dementia, which can severely affect an individual’s ability to perform daily activities and therefore their overall quality of life. If we can better understand how HIV causes cognitive impairment, how to use biomarkers to predict and identify it, and most importantly, how to effectively treat it, we could better the lives of tens of millions of people. HIV-associated cognitive disorder (HAND) is a serious issue here in America, but it is a significantly larger issue in developing countries. Medical professionals continue to create new and better treatments, but majority of the world’s HIV+ population is unable to access or afford these treatments. When analyzing HAND treatments, it is critical to examine the effectiveness of treatment from a biological standpoint, while also considering factors such as education, economic status, and access to healthcare.

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