Highly active antiretroviral therapy (HAART) in the prevention and treatment of HIV-associated neurocognitive disorder

Abstract

Overview - Despite promising effects of Highly Active Antiretroviral Therapy (HAART) in improving neurocognition in HIV-infected patients, mild forms of HIV-associated neurocognitive disorder (HAND) persist; hence the objective of this dissertation is to explore whether HAART can prevent and treat HAND. Research Question- In adult patients infected with HIV, is Highly Active Antiretroviral Therapy (HAART) effective in the prevention and treatment of HIVassociated neurocognitive disorder (HAND)? PICO elements- Population (P) - adult patients with HIV, Intervention (I) -HAART, Comparison (C) - no treatment, Outcome (O) - prevention and treatment of HAND Inclusion/Exclusion criteria- Included studies - i. focused on HAART ii. lie at the apex of the hierarchy of evidence iii. investigated HAND iv. focused on neurocognitive impairment caused by HIV only Search Outcome- Databases on EBSCOhost and PubMed were searched. Three systematic reviews, four RCTs and three prospective cohort studies were retrieved and reviewed to answer these questions. Critical Appraisal- CASP checklists for systematic reviews/meta-analyses, randomised controlled trials (RCTs) and cohort studies were used for critical appraisal Results- All studies confirmed the beneficial effect of HAART in treating HAND and reducing neurocognitive impairment (NCI). Some questions remain unanswered especially concerning the prevention of HAND. Harezlak et al. (2011) indicated that cerebral inflammatory changes persist despite HAART use. Conclusions- HAART is effective in treating HAND/NCI in adult patients with HIV, though it is unclear whether HAART prevents HAND/NCI. Implications and Recommendations- It is evident that HAART can treat HAND/NCI. Further research is required to determine- whether it can prevent HAND/NCI, optimal treatment for HAND and adjuvant/adjunctive therapies targeting viral replication within the brain. Nurses should screen patients having HIV for NCI/HAND and be aware of predisposing risk factors. They should educate/inform patients regarding HAND/NCI. Health and social care policies should recognise the importance of HAND/NCI in the local context.