Role of nuclear medicine in neuroHIV: PET, SPECT, and beyond

HIV-associated neurocognitive disorders (HAND) remain among the most common clinical disorders encountered in people infected with HIV despite widespread use of antiretroviral therapy. There is an enormous need for further evaluation and early diagnosis of HAND. The variety of PET agents such as FDG, ¹¹C-PiB and [¹¹C]-R-PK11195 as well as SPECT agents ⁹⁹Tc-HMPAO, ¹²³I-FP-CIT and ¹²³I-IBZM have been investigated for the diagnosis of HAND, for distinguishing between demented and nondemented HIV patients, for differentiation between HAND and nonHIV related dementia, as well as for assessing the influence of coinfection with the other viral pathogens on the brain functionality. In spite of some interesting results, none of these tracers have been specifically created for HAND and none can be recommended for HAND diagnosis. Specialized tracers need to be developed for better diagnosis and management of HAND. The potential role of therapeutic nuclear medicine as part of the curative strategies for HIV is also discussed.