The risk of an HIV-associated neurocognitive disorder (HAND), increases over the lifetime of an HIV+ patient. Complications can involve the central nervous system (CNS) and/or the peripheral nervous system (PNS). The effects may be acute, chronic or progressive. This course will focus on the chronic and progressive neurocognitive changes associated with HIV infection of the CNS.

HIV enters the CNS soon after infection and thereafter resides permanently in the DNA of infected cells. Unfortunately many antiretroviral medications cannot cross the blood brain barrier. As a result, the CNS can act as a protected reservoir for HIV sequestration and replication.

The neurologic complications of HIV have been associated with the level of immunodeficiency. For example, meningitis, acute encephalitis, Guillain-Barre syndrome, cranial nerve palsy are most common in the early stage of HIV infection (CD4>500 cells/mm3). Minor Cognitive-Motor disorder (MCMD) now known as mild cognitive disorder (MCD), myelopathy and myopathy are more common in moderate to severe immunodeficiency (CD4 200-500 cells/mm3). AIDS Dementia Complex (ADC) now known as HIV-associated dementia (HAD) is most common in the late stage of HIV/AIDS (CD4 <200 cells/mm3). HAD is an AIDS-defining condition.

Introduction of combined highly active antiretroviral treatment (HAART) has changed the course of HIV/AIDS. HAART has reduced AIDS defining illness, prolonged survival and allowed many patients to partially restore their immune response. As a result, the incidence of HAD has significantly declined but the prevalence of the more mild form of HIV associated neurocognitive disorder MCD has increased.

This course is intended to familiarize healthcare professionals with the terminology, pathophysiology and treatment strategies associated HAND. Healthcare professionals can assisted caregivers and patients to enhance safety, treatment compliance and quality of life by individualizing effective interventions.

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