Because effective antiviral therapy can suppress HIV replication and prolong the life of HIV-infected patients to that approaching non-infected individuals long term complications of antiviral therapy acquire particular importance. Among these are neuro-cognitive disorders.

Neurocognitive impairment, ranging from mild deficits to severe dementia, occurs in about half of HIV-infected individuals. A recent study by McCutchan et al has suggested that increased waist circumference was associated with increased prevalence of neuroognitive impairment in a subgroup of HIV-infected patients followed up in the CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) study. They found that central obesity, but not more generalized increases in body mass (BMI), was associated with a higher prevalence of neurocognitive impairment (NCI) in HIV+ persons. Diabetes appeared to be associated with NCI only in older patients.

These findings are similar to those reported in the non-infected populations with central obesity – known as metabolic syndrome. the mechanisms for these findings are unclear. However as central obesity and metabolic syndrome appear to be common in HIV-infected patients receiving antiviral therapy these findings may have important implication for patients.The authors concluded that avoidance of antiretroviral drugs that induce central obesity might protect from or help to reverse neurocognitive impairment in HIV-infected persons.

Research on the long term metabolic effects of anti-retroviral treatment, which has focused on the mechanisms for increased incidence of cardiovascular disease seen in patients on treatment should be widened to include neurocognitive impairment and its relations to central fat accumulation.