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Clinical Treatment Options and Randomized Clinical Trials for Neurocognitive Complications of HIV Infection: Combination Antiretroviral Therapy, Central Nervous System Penetration Effectiveness, and Adjuvants

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Neurocognitive Complications of HIV-Infection

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 50))

Abstract

The etiology and pathogenesis of human immunodeficiency virus type-I (HIV)-associated neurocognitive disorders (HAND) remain undetermined and are likely the produce of multiple mechanisms. This can mainly include neuronal injury from HIV, inflammatory processes, and mental health issues. As a result, a variety of treatment options have been tested including NeuroHIV-targeted regimens based on the central nervous system (CNS) penetration effectiveness (CPE) of antiretroviral therapy (ART) and adjuvant therapies for HAND. NeuroHIV-targeted ART regimens have produced consistent and statistically significant HIV suppression in the CNS, but this is not the case for cognitive and functional domains. Most adjuvant therapies such as minocycline, memantine, and selegiline have negligible benefit in the improvement of cognitive function of people living with HIV (PLWH) with mild to moderate neurocognitive impairment. Newer experimental treatments have been proposed to target cognitive and functional symptoms of HAND as well as potential underlying pathogenesis. This review aims to provide an analytical overview of the clinical treatment options and clinical trials for HAND by focusing on NeuroHIV-targeted ART regimen development, CPE, and adjuvant therapies.

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Acknowledgments

Drs. Scott Letendre and Qing Ma are currently supported in part by NIH grant R01AG063659.

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Authors and Affiliations

  1. Department of Pharmacy Practice, University at Buffalo, Buffalo, NY, USA

    Shih-Ping Lin & Qing Ma

  2. Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Ping Lin

  3. Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy

    Andrea Calcagno

  4. Department of Medicine and Psychiatry, HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, USA

    Scott L. Letendre

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  1. Shih-Ping Lin
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  2. Andrea Calcagno
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Correspondence to Qing Ma .

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Editors and Affiliations

  1. School of Psychology, The University of New South Wales, Sydney, NSW, Australia

    Lucette A. Cysique

  2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute St. Michael’s Hospital and Unity Health Toronto, Toronto, ON, Canada

    Sean B. Rourke

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Lin, SP., Calcagno, A., Letendre, S.L., Ma, Q. (2020). Clinical Treatment Options and Randomized Clinical Trials for Neurocognitive Complications of HIV Infection: Combination Antiretroviral Therapy, Central Nervous System Penetration Effectiveness, and Adjuvants. In: Cysique, L.A., Rourke, S.B. (eds) Neurocognitive Complications of HIV-Infection. Current Topics in Behavioral Neurosciences, vol 50. Springer, Cham. https://doi.org/10.1007/7854_2020_186

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