Neurological impairment in patients with HIV on antiretroviral therapy: literature review

Agnė Augustaitytė1, Miglė Puodžiūnaitė1, Tomas Šarnauskas1

1 Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania


Human immunodeficiency virus (HIV) is a retrovirus that causes autoimmune deficiency syndrome (AIDS). In Lithuania, as in many European countries, HIV-1 is the most common type of HIV and is most often transmitted during sexual intercourse. HIV-infected patients receive antiretroviral therapy (ART), which is usually a combination of several antiretroviral drugs (ARVs) that target specific events in pathogenesis of HIV. The most widely used ARV groups are nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), CCR5 antagonists, fusion inhibitors, HIV-1 protease inhibitors, pharmacokinetic enhancers, and integrases. CCR5 antagonists and fusion inhibitors stop the interaction between HIV and the host cell by inhibiting HIV attachment and penetration into CD4 cells. Inside the host cell, NRTIs and NNRTIs disrupt the HIV reverse transcription process, thereby stopping the synthesis of double-stranded DNA, integrases prevent the integration of HIV DNA into the host cell DNA, and HIV protease inhibitors inhibit the synthesis of HIV proteins. In addition, pharmacokinetic enhancers inhibit CYP3A4, thereby increasing the effects of other ARVs. HIV, on the other hand, is highly neurotropic and is therefore associated with the development of neurological symptoms and signs even in patients on ART. Some of the most common neurological disorders, also known as HIV-associated neurocognitive disorders (HAND), are HIV-associated dementia (HAD) and mild neurocognitive disorder (MND). HAND is associated in changes in cognitive activity, motor skills, and behavior that ART often fails to suppress. In contrast, adverse reactions in some ARV groups may have negative effects on patients’ neurological status.

Keywords: HIV associated dementia, neurocognitive disorders, retrovirus, antiretroviral therapy.