Cognitive neurorehabilitation of HIV-associated neurocognitive disorders: a qualitative review and call to action

Abstract

Despite significant advances in the virologic management of HIV infection over the last two decades, effective treatments for HIV-associated neurocognitive disorders (HAND) remain elusive. While pharmacological interventions have yielded some success in improving neurocognitive outcomes in HIV, there is a dearth of rigorous studies examining the efficacy of cognitive rehabilitation for remediating HIV-associated neurocognitive impairment. This qualitative review summarizes and critiques the emerging literature on cognitive and behavioral treatments for HAND, which provides many reasons for optimism, but also has major limitations that underscore the scope of the work that lies ahead. Considering the notable real-world consequences of HAND, the development, validation, and clinical deployment of cognitive neurorehabilitation interventions tailored to the needs of persons living with HIV infection is a priority for clinical neuroAIDS investigators. In describing potential future directions for this endeavor, particular attention was paid to the application of cognitive neuropsychological principles in developing theory-driven approaches to managing HAND, improving everyday functioning, and enhancing HIV health outcomes.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1

Decision-tree outlining the consensus Frascati diagnostic criteria for HIV-Associated Neurocognitive Disorders (HAND) as adapted from Antinori et al. (2007) and Woods et al. (2009). MDD = major depressive disorder. SD = standard deviation.

Figure 2

A preliminary conceptual model depicting possible targets for prevention and rehabilitation of the neuropathogenesis, affected brain systems, neurocognitive deficits, and real-world impact of HIV-Associated Neurocognitive Disorders (HAND). ART = antiretroviral therapy. IADL = instrumental activities of daily living. WM = working memory.