Cognitive and Neurologic Rehabilitation Strategies for Central Nervous System HIV Infection
- PDF / 764,877 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 35 Downloads / 192 Views
CENTRAL NERVOUS SYSTEM AND COGNITION (SS SPUDICH, SECTION EDITOR)
Cognitive and Neurologic Rehabilitation Strategies for Central Nervous System HIV Infection Terrence Chan 1 & Monica Marta 2,3 & Camilla Hawkins 1 & Simon Rackstraw 1,2,3 Published online: 26 August 2020 # The Author(s) 2020
Abstract Purpose of Review Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. Recent Findings Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Summary Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH. Keywords Cognitive rehabilitation . Neuro-rehabilitation . HIV-associated neurocognitive disorders . HIV
Introduction HIV-associated neurocognitive disorder (HAND) was characterised by severe cognitive dysfunction leading to dementia and death in the pre-antiretroviral era [1]. The introduction of combination antiretroviral therapy (cART) decreased the incidence of the most severe HAND cases [2–4]. It also transformed the management of HIV infection from the symptomatic control of a life-limiting disease to the care of a chronic condition that is associated with a close to normal lifespan [5]. Whilst the most severe forms of HAND are now rare, milder cognitive impairments persist amongst PLWH [3, 6, This article is part of the Topical Collection on Central Nervous System and Cognition * Simon Rackstraw [email protected] 1
Mildmay Hospital, 19 Tabernacle Gardens, London E2 7DZ, UK
2
Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK
3
Neurosciences, Blizard Institute, Queen Mary University of London, London, UK
7]. Recent study cohorts suggest that cART does not alter the prevalence of cognitive impairment in PLWH [6, 8, 9]. Furthermore, new HIV-related neurological complications have become apparent with the widespread use of cART. Encephalopathy due to HIV discordance between plasma and cerebrospinal fluid (CSF) [10–12] and CD8 encephalitis [13] is rare but recognisable central nervous system (CNS) presentations seen in PLWH on cART. It has also emerged that some antiretrovirals, such as efavirenz, have direct CNS toxicity [14, 15]. HIV infection is also associated with a higher risk of cerebro- and cardiovascular disease, either by lif
Data Loading...
