View source for HIV-associated neurocognitive disorder

== 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 ==

* Must rule out CNS viral escape with CSF HIV viral load compared to simultaneous plasma viral load
* 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

{| class="wikitable"
!
!Neurocognitive Status
!Functional Status
|-
|Asymptomatic neurocognitive impairment
| rowspan="2" |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
|}
[[Category:HIV]]