HIV INFECTION AND AIDS: Edited by Martin FisherNeurocognitive dysfunction in the highly active antiretroviral therapy eraMothobi, Nomvuyo Z.; Brew, Bruce J.Author Information aDepartment of Neurology and HIV Medicine, St. Vincent's Hospital bSt Vincent's Centre for Applied Medical Research, Darlinghurst, Sydney, New South Wales, Australia Correspondence to Professor Bruce J. Brew, Department of Neurology, Level 4 Xavier Building, St. Vincent's Hospital, Sydney, NSW 2010, Australia. E-mail: B.Brew@UNSW.edu.au Current Opinion in Infectious Diseases: February 2012 - Volume 25 - Issue 1 - p 4-9 doi: 10.1097/QCO.0b013e32834ef586 Buy Metrics Abstract Purpose of review The aim is to review the recent confirmation of the continued high prevalence of HIV-associated neurocognitive disorders (HAND) despite highly active antiretroviral therapy (HAART) in a large cohort study and to review the recent studies that have begun to address the potential reasons for such persistence. Recent findings HAND remains prevalent, despite effective viral suppression in cerebrospinal fluid and plasma. Several studies have shown the benefit of a central nervous system (CNS) penetrating HAART regimen (neuro-HAART) in improving neurocognitive outcomes. New evidence supports the early initiation of HAART. There are recent data to suggest that HAART may be CNS toxic, but evidence is still limited. Ageing does not currently explain the persistence of HAND. A recent study has also shown a correlation between cardiovascular risk factors and HAND. Summary The prevalence of HAND remains high in the HAART era. Most studies point towards the benefit of neuro-HAART in the prevention and treatment of HAND. The possible neurotoxicity of HAART needs to be further evaluated. It may be too early to detect a combined ageing and HIV effect and long-term studies are required. The link between cardiovascular disease and neurocognitive decline in HIV needs further exploration. Effective screening in clinical practice is paramount in prevention of the morbidity and mortality associated with HAND. Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.