HIV in the Brain: From Devastating Dementia to White Matter Hyperintensities

Since the beginning of the HIV epidemic, the potentially devastating effect of HIV infection in the brain has been recognized. Clinical accounts from the 1990s documented cases of severe, rapidly progressive dementia, and early autopsy series revealed abnormalities in 90% of the brains studied.1,2 Fortunately, as antiretroviral therapy (ART) was introduced, HIV infection became a chronic, treatable condition that allowed people with HIV to achieve normal lifespans. In addition, the cognitive impact of HIV infection lessened in the ART era but did not disappear.3 Rather than a relentlessly progressive dementia, HIV-associated cognitive deficits have evolved into the HIV-associated neurocognitive disorder of today, which is significantly milder and typically nonprogressive but still affects up to half of people with HIV.4–6

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