Advances in assessment and cognitive neurorehabilitation of HIV-related neurocognitive impairment.

Abstract

Neurocognitive impairment (NCI) is present in around 40% of people with HIV and substantially affects everyday life, adherence to combined antiretroviral therapy (cART) and overall life expectancy. Suboptimal therapy regimen, opportunistic infections, substance abuse and highly prevalent psychiatric co-morbidities contribute to NCI in people with HIV. In this review, we highlight the need for efficacious treatment of HIV-related NCI through pharmacological approaches and cognitive neurorehabilitation, discussing recent randomized controlled trials in this domain. We also discuss the benefits of a thorough and interdisciplinary diagnostic work-up between specialists in neurology, psychiatry, neuropsychology and infectious diseases, helping to disentangle the various factors contributing to cognitive complaints and deficits in people with HIV. While the advent of cART has contributed to slowing the progression of cognitive deficits in people with HIV and reducing the prevalence of HIV-associated dementia, NCI persists at a significant rate. Adjuvant stimulating or neuroprotective pharmacological agents have shown some potential benefits. Despite promising outcomes, studies on cognitive neurorehabilitation of HIV-related NCI remain sparse and limited in terms of methodological aspects. The access to cognitive neurorehabilitation is also restricted, in particular at the global scale. Novel technology bears a significant potential for restoring cognitive function in people with HIV, affording high degrees of standardization and personalization, along with opportunities for telerehabilitation. Entertaining serious video game environments with immersive graphics can further promote patient motivation, training adherence and impact on everyday life, as indicated by a growing body of evidence, including in seropositive children and older individuals in Africa. Upon validation of technology-assisted cognitive neurorehabilitation for HIV-related NCI in large-scale randomized controlled trials with state-of-the-art methodology, these approaches will promote socio-professional reintegration and quality of life of people with HIV.