Asymptomatic neurocognitive disorders in patients infected by HIV: fact or fiction?
1 Institute for Infectious and Tropical Diseases, University of Brescia, P.le Spedali Civili, 125123 Brescia, Italy
2 Medical Statistics and Biometry Section, University of Brescia, Centro Didattico Polifunzionale, Viale Europa, 11 25123 Brescia, Italy
3 Infectious and Tropical Diseases Department, APHP, Tenon Hospital, Paris 6 University, Rue de la Chine, 4 75020 Paris, France
BMC Medicine 2011, 9:138 doi:10.1186/1741-7015-9-138Published: 28 December 2011
Neurocognitive disorders are emerging as a possible complication in patients infected with HIV. Even if asymptomatic, neurocognitive abnormalities are frequently detected using a battery of tests. This supported the creation of asymptomatic neurocognitive impairment (ANI) as a new entity. In a recent article published in BMC Infectious Diseases, Magnus Gisslén and colleagues applied a statistical approach, concluding that there is an overestimation of the actual problem. In fact, about 20% of patients are classified as neurocognitively impaired without a clear impact on daily activities. In the present commentary, we discuss the clinical implications of their findings. Although a cautious approach would indicate a stricter follow-up of patients affected by this disorder, it is premature to consider it as a proper disease. Based on a review of the data in the current literature we conclude that it is urgent to conduct more studies to estimate the overall risk of progression of the asymptomatic neurocognitive impairment. Moreover, it is important to understand whether new biomarkers or neuroimaging tools can help to identify better the most at risk population.