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Chapter 30 : Ethnicity and Neuro-AIDS Conditions in the HAART Era
Category: Viruses and Viral Pathogenesis
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The nature of neurocognitve impairment associated with HIV has changed, after the introduction of highly active antiretroviral therapy (HAART), to more subtle forms, requiring the establishment of new definitional criteria. Recently, the neurological spectrum of HIV-1 infection has been divided into the eras before and after HAART. Antiretroviral (ARV) therapy has had a direct impact on patient survival and the clinical manifestations of neurological complications. In the pre-HAART era, the most common neurological complications were HIV encephalitis, cytomegalovirus infection, toxoplasmosis, cryptococcus infection, and progressive multifocal leukoencephalopathy. The role of host factors in HIV-1-associated dementia (HAD) has been illustrated by finding genetic mutations associated with the disease. The presence of neurocognitive impairment in HIV-1-infected individuals, which varies from subtle, mild deficits (e.g., asymptomatic with subclinical neuropsychological deficits) to minor cognitive-motor disorder (MCMD) to HAD, is one of the common neurological, neuropsychological, and neuropsychiatric complications of HIV-1 infection. There is limited literature regarding neuro-AIDS complications in ethnic groups and special populations. Assessing for neurocognitive performance in ethnic groups is critical to establish population-specific normative standards and culturally valid tests. Ethnic, gender, education or literacy, genetic, and age factors may contribute to different manifestations of HIV-1 cognitive impairment; consequently, they should be considered in research design. It is possible that the different scales used for HIV-1 cognitive function (Memorial Sloan Kettering, HDS, and AAN criteria) may fail to correctly identify cognitive impairment in different ethnic groups.