11 Interestingly, recent studies have also found increased permeability of the blood-brain barrier in older adults. 8, 10 In addition, different antiretroviral medications have been shown to vary considerably in their ability to penetrate the central nervous system (CNS) and reduce CNS HIV viral load. 8, 9 Unfortunately, objective measures show that only 50%–60% of HIV-infected patients achieve adequate adherence to their medications. For example, consistently high levels of adherence are needed to modulate certain aspects of immune functioning (e.g., antigen-specific responses and cytokine production) and successfully reconstitute or maintain desirable levels of immune functioning. However, a number of factors are likely to moderate the neuroprotective effects of HAART. In addition to increased CD4 count and reduced HIV viral load, 3, 4 HAART can bolster patients’ motor functioning, processing speed, memory, and general cognition. 2 Advances in the treatment of HIV infection, such as the advent of highly active antiretroviral treatment (HAART), have been shown to greatly improve markers of immune function, with positive consequences downstream. 1, 2 This profile of neurocognitive impairment has been interpreted as reflecting a primarily frontal-subcortical pathogenesis and tends to increase in severity with progression from nonsymptomatic to AIDS phases of HIV illness. HIV infection can result in significant neurocognitive dysfunction, most prominently in the domains of motor functioning, attention, processing speed, executive functioning, and memory.
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