HIV-associated neurocognitive disorder
From IDWiki
Background
- Previously called AIDS dementia complex
Epidemiology
- Severe HAND less common following ART
- First factors include lack of viral suppression, low nadir CD4 count, and increasing age
- Other risk factors include hypertension, dyslipidemia, diabetes, and coinfections such as hepatitis C
Clinical Manifestations
- Spectrum that includes asymptomatic neurocongitive impairment (impairment only noted on formal tests), mild neurocognitive disorder (affects functioning), and HIV-associated dementia (inability to perform ADLs)
- Not necessarily progressive
- Wide range of symptoms, including inattention, poor concentration, irritability, apathy, mood changes, motor dysfunction
- Head imaging often shows global atrophy
Differential Diagnosis
- CNS viral escape, with CSF HIV viral load compared to simultaneous plasma viral load
- Primary CNS lymphoma
- Progressive multifocal leukoencephalopathy caused by JC virus
- Cryptococcus
- Toxoplasma
- Obstructive sleep apnea
- Low vitamin B12
- Thyroid disease
- Syphilis
- Other causes of cognitive impairment unrelated to HIV, including subclinical depression, drug use, educational deprivation, socioeconomic status, and Alzheimer dementia
Diagnostic Criteria
- Uses the Frascati criteria 2007
- Based on formal assessment of at least five neurocognitive domains, including attention-information processing, language, abstraction-executive, complex perceptual motor skills, memory including learning and recall, simple motor skills or sensory perceptual skills
- Exclusion of other causes
| Neurocognitive Status | Functional Status | |
|---|---|---|
| Asymptomatic neurocognitive impairment | 1 SD below mean in 2 cognitive domains | no impairment in activities of daily living |
| Mild neurocognitive disorder | impairment in activities of daily living | |
| HIV-associated dementia | 2 SD below mean in 2 cognitive domains | marked impairment in activities of daily living |
