HIV infection and AIDS primarily affect the immune system. Long-term untreated HIV infection is associated with a range of neurological disorders, including: Asymptomatic Neuropsychological Impairment (ANI), Mild Neurocognitive Disorder (MND), and HIV-Associated Dementia (HAD).
Treatment of HIV infection, with antiretroviral therapy (ART) has significantly reduced the risk of the most severe HIV-induced dementia. However, milder forms of neurocognitive impairment remain common, affecting a substantial portion of individuals with HIV (Hussain et al., 2024).
Combination antiretroviral therapy (cART), a combination of HIV medications taken daily, helps stop HIV from replicating and spreading in the body. Despite cART viral suppression, people living with HIV are still at risk for central nervous system diseases associated with HIV. These diseases can be neurological or neurocognitive (NIMH n.d.).
It is estimated that 50% of HIV+ people have some degree of neurocognitive impairment (Valcour, VG (2013). Neurocognitive deficits are the primary complaint in 4 to 15 percent of patients with HIV-associated neurocognitive disorder (HAND) describes a spectrum of progressively more severe neurologic and cognitive symptoms (Kopstein 2020).
The United States National Institutes of Health published a classification scheme in 2007 to define these neuropsychiatric disorders so that there may be uniformity in clinical assessments and research for these disorders. This classification system is called the "Frascati criteria," This classification can only be applied when neurocognitive impairment cannot be explained by any other condition (Mitra & Sharman, 2022, Oct 20).
Criteria for HIV-Associated Neurological Disorders (HAND) |
|
| Type | Description |
| Asymptomatic Neuropsychological Impairment (ANI) | When the individual scores 1 standard deviation (SD) or more below the mean in 2 or more cognitive domains on standardized neuropsychological testing. There is usually no overt functional impairment. |
| Mild Neurocognitive Disorder (MND) | When the individual scores 1 SD or more below the mean in 2 or more cognitive domains on standardized neuropsychological testing AND has evidence of overt (usually mild) functional impairment. |
| HIV-Associated Dementia (HAD) | When the individual scores 2 SD or more below the mean in 2 or more cognitive domains on standardized neuropsychological testing AND has evidence of functional impairment affecting activities of daily living. |
| Mitra P, Sharman T. HIV Neurocognitive Disorders. [Updated 2022 Oct 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555954/ | |
Recently, there have been calls for improved consensus regarding the classification of cognitive impairment in people living with HIV. Nightingale, et al. believe the current diagnostic criteria overestimate or falsely classify 20% of cognitively healthy individuals as having cognitive impairment.
They believe cognitive test performance is strongly influenced by complex educational, cultural and socioeconomic factors, which can interact with HIV risk such that low cognitive test performance might not correspond to a pathological state. They also believe that Imprecise categorizing of cognitive impairment can limit research, biomarker discovery and treatment trials.
Until a consensus is reached, health care providers should encourage patients to report any changes in their mental health, such as slowed thinking or how they feel about themselves and life in general. People living with HIV should also discuss any alcohol or substance use, over-the-counter or prescribed medications they may be taking, including any psychiatric medicines, because some of these drugs may interact with antiretroviral medications.
Reference
Hussain, H., Fadel, A., Garcia, E., Michel, G., Saadoon, Z. F., Fernandes, A., Jarrett, O., Naseer, L., Abellard, R.-B., & Dalgado, P. (2024). HIV and dementia. The Microbe, 2, 100052. https://doi.org/10.1016/j.microb.2024.100052
Kopstein M, Mohlman DJ. HIV-1 Encephalopathy And Aids Dementia Complex. [Updated 2020 Jun 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507700/
Mitra P, Sharman T. HIV Neurocognitive Disorders. [Updated 2022 Oct 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555954/
"Neurological Complications of AIDS Fact Sheet", NINDS, Publication date: June 2019. NIH Publication No. 19-NS-5319
Nightingale, S., Ances, B., Cinque, P. et al. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol 19, 424–433 (2023). https://doi.org/10.1038/s41582-023-00813-2
The National Institute of Mental Health (NIMH, n.d.). HIV/AIDS and Mental Health. reviewed
Accessed 4/30/21 from https://www.nimh.nih.gov/health/topics/hiv-aids
Valcour VG (2013) . HIV, aging, and cognition: emerging issues. Top Antivir Med. Jul–Aug 2013;21(3):119–23. Icahn School of Medicine at Mount Sinai. Manhattan HIV Brain Bank. Overview. 2013. Available at: http://icahn.mssm.edu/ research/programs/manhattan-hiv-brain-bank/about-us.
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