Neurocognitive Phenotyping of HIV in the Era of Antiretroviral Therapy.

Purpose of review: This paper examines the theoretical and empirical basis for neurocognitive phenotyping of HIV. Recent findings: The pattern of neurocognitive symptoms associated with HIV has traditionally been referred to as a "subcortical" phenotype. Recent concern has been raised that the neurocognitive phenotype in the post-ART era has changed to reflect the addition of cortical features, suggestive of synergistic age-related neurodegeneration. Empirical evidence reviewed in this paper suggests that, when present, HIV-related neurocognitive impairment in the post-ART era remains subcortical in nature, regardless of advanced age or treatment status. Persistent neurocognitive impairment among virally suppressed individuals may reflect a combination of HIV disease factors, pre-existing risk factors, and/or emergent health comorbidities such as subcortical ischemic vascular disease in older people living with HIV. An entrenchment of the subcortical neurocognitive phenotype of HIV appears to be unfolding in the post-ART era. Whether new neurocognitive subtypes of HIV exist in the current era requires additional research utilizing harmonized test protocols and advanced computational methods capable of deep phenotyping. Recommendations from other neurological disorders are provided.