Risk factors for HIV-associated neurocognitive disorders

HIV-associated neurocognitive disorders (HAND) are influenced by various risk factors that can impact the development and severity of cognitive impairment. These risk factors are multifaceted and can vary from individual to individual. Here is an overview of several risk factors associated with HAND:

Advanced HIV disease stage:

Individuals with advanced HIV infection, particularly those with low CD4 + T-cell counts, are at a higher risk of developing HAND. CD4 + T-cell counts below 200 cells/mm³ are associated with an increased risk of cognitive impairment (Mitra, 2022).

High viral load in the central nervous system (CNS):

Elevated HIV viral load in the cerebrospinal fluid (CSF) and brain tissues is a significant risk factor for HAND. The virus can directly affect the central nervous system, leading to neuroinflammation and neuronal damage.(Moulignier, A. 2021)

Duration of HIV infection:

Longer durations of HIV infection are associated with an increased risk of developing HAND. Chronic exposure to the virus and persistent immune activation can contribute to cognitive impairment (Saylor, D. 2016).

Antiretroviral therapy (ART) adherence:

Poor adherence to ART regimens can lead to incomplete viral suppression in the peripheral and CNS compartments. Inadequate viral control can contribute to the development or progression of HAND (Gisslén et al., 2011)

Aging:

Advancing age is a known risk factor for HAND. Older individuals with HIV may experience cognitive decline related to HIV infection and age-related factors (Ellis et al., 2011).

Comorbid medical conditions:

Comorbid conditions such as diabetes, hypertension, and cardiovascular disease can increase the risk of vascular-related cognitive impairment in individuals with HIV (Ojagbemi (2021).

Substance abuse:

Substance abuse, mainly using drugs like methamphetamine, cocaine, and opioids, can exacerbate neurocognitive deficits in individuals with HIV (Ojagbemi (2021).

Hepatitis C co-infection:

Co-infection with hepatitis C virus (HCV) is associated with an increased risk of cognitive impairment. The mechanisms underlying this risk are not fully understood but may involve shared neuroinflammatory pathways (Kolson, 2022)

Neurological opportunistic infections:

Opportunistic infections that affect the central nervous system, such as toxoplasmosis or cryptococcal meningitis, can contribute to cognitive impairment in individuals with HIV (Lin, 2021).

Psychosocial factors:

Psychosocial factors, including stress, depression, and social isolation, can impact cognitive function. Depression, in particular, is common among individuals with HAND and can contribute to cognitive deficits (Force et al., 2021)

Genetic factors:

Certain genetic factors may increase susceptibility to HAND. Variations in genes related to neuroinflammation and synaptic function have been investigated as potential risk factors (Eaton et al.,2020).

Neurological biomarkers:

Elevated levels of neuroinflammatory biomarkers in the cerebrospinal fluid, such as neopterin and quinolinic acid, are associated with an increased risk of HAND (Safro 2021).

Immune activation:

Persistent immune activation and systemic inflammation, even in individuals on successful ART, are linked to an increased risk of cognitive impairment (Robertson et al., 2007)
TABLE SOURCE: Elendu, C., Aguocha, C. M., Okeke, C. V., Okoro, C. B., & Peterson, J. C. (2023). HIV-related neurocognitive disorders: Diagnosis, Treatment, and Mental Health Implications: A Review. Medicine, 102(43), e35652. https://doi.org/10.1097/MD.0000000000035652

 

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