HIV Associated Neurocognitive Disorder (HAND): Difference between revisions
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== Introduction == | == Introduction == | ||
People living HIV | People living HIV (PLWH) are at risk of developing a range of cognitive, motor, and/or mood problems collectively known as HIV-Associated Neurocognitive Disorder (HAND). Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. Typical symptoms include difficulties with attention, concentration, and memory; loss of motivation; irritability; depression; and slowed movements. | ||
Initially | Among HIV infected patients cognitive impairment was and is one of the most feared complications of HIV infection. In addition neurocognitive impairment may affect adherence to treatment and ultimately result in increased morbidity and mortality. | ||
HAND is not necessarily a progressive disorder that worsens with time. | |||
=== Epidemiology === | |||
The exact prevalence of HAND among PLWH is not well known, as the diagnostic criteria and tools are not very sensitive of specific. There is a wide variation in prevalence between and within countries<ref name=":0">Howlett WP. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794503/ Neurological disorders in HIV in Africa: a review.] African health sciences. 2019 Aug 20;19(2):1953-77.</ref>, but overall studies have shown a reduction in the burden of HAND since the introduction of ART. The mean prevalence of HAND in in the post-ART era in Africa is estimated to be 30.4%<ref name=":0" /> | |||
* Zambia: 22-24.6% | |||
* Malawi: 14% | |||
* Uganda: 64.4% | |||
* South Africa: 18-80% | |||
=== Categories of HAND === | |||
Initially known as AIDS Dementia Complex, HAND is categorized into three levels of functional impairment. | |||
# '''Asymptomatic Neurocognitive Impairment (ANI)''' is a mild form of HAND with impaired performance on neuropsychological tests, but affected individuals report independence in performing everyday functions | |||
# '''Mild Neurocognitive Disorder (MND)''' is a common form of HAND that mildly interferes with everyday function. | |||
# '''HIV-associated Dementia (HDA)''' refers to HAND in its most severe form, where there is an inability to complete daily tasks independently. | |||
== Aetiology == | == Aetiology == | ||
HAND is a caused by direct effects of the HIV infection, independent of opportunistic infections. | |||
'''Possible risk factors for HAND'''<ref name=":0" />''':''' | |||
* Advanced age | |||
* Advanced WHO clinical stage | |||
* Low CD4 count | |||
* Anaemia | |||
== Clinical Presentation == | |||
'''Pre-ART HAND:''' psychomotor slowing - inattention, slow thinking, forgetfulness, unsteady gait, tremor, social withdrawal<ref name=":0" /> | |||
'''Post-ART HAND:''' more cortical involvement - impaired learning ability, memory executive function and extrapyramidal motor features<ref name=":0" /> | |||
== Outcome Measures == | |||
* International HIV Dementia Scale (IHDS): Measures motor speed, psychomotor speed and learning, registration and memory; a score of <10 is regarded to be indicative of HAND, but poor sensitivity and specificity means that this test can not be used in isolation.<ref name=":0" /> | |||
== Management == | == Management == | ||
The most important strategy is to start ART as early as possible (which also implies early detection of HIV infection). Other strategies aimed at reducing inflammation - such as methotrexate, statins and antiepileptic medication - do not seem to have significant effects.<ref name=":0" /> | |||
=== ART === | |||
Early initiation of ART helps to prevent HAND in PLWH. In patients who already present with HAND, some improvement may occur once ART is initiated, but these improvements usually plateau after 9-months on ART. Many patients affected by HAND will experience persistence of symptoms. | |||
Combined ART regimes with better central nervous system penetration can help to prevent HAND. | |||
== Resources == | == Resources == | ||
Revision as of 08:47, 24 October 2023
Original Editor - Blessed Denzel Vhudzijena
Top Contributors - Melissa Coetsee, Blessed Denzel Vhudzijena and Kim Jackson
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (23/03/23)
Introduction[edit | edit source]
People living HIV (PLWH) are at risk of developing a range of cognitive, motor, and/or mood problems collectively known as HIV-Associated Neurocognitive Disorder (HAND). Although severe and progressive neurocognitive impairment has become rare in HIV clinics in the era of potent antiretroviral therapy, most patients with HIV worldwide have poor outcomes on formal neurocognitive tests. Typical symptoms include difficulties with attention, concentration, and memory; loss of motivation; irritability; depression; and slowed movements.
Among HIV infected patients cognitive impairment was and is one of the most feared complications of HIV infection. In addition neurocognitive impairment may affect adherence to treatment and ultimately result in increased morbidity and mortality.
HAND is not necessarily a progressive disorder that worsens with time.
Epidemiology[edit | edit source]
The exact prevalence of HAND among PLWH is not well known, as the diagnostic criteria and tools are not very sensitive of specific. There is a wide variation in prevalence between and within countries[1], but overall studies have shown a reduction in the burden of HAND since the introduction of ART. The mean prevalence of HAND in in the post-ART era in Africa is estimated to be 30.4%[1]
- Zambia: 22-24.6%
- Malawi: 14%
- Uganda: 64.4%
- South Africa: 18-80%
Categories of HAND[edit | edit source]
Initially known as AIDS Dementia Complex, HAND is categorized into three levels of functional impairment.
- Asymptomatic Neurocognitive Impairment (ANI) is a mild form of HAND with impaired performance on neuropsychological tests, but affected individuals report independence in performing everyday functions
- Mild Neurocognitive Disorder (MND) is a common form of HAND that mildly interferes with everyday function.
- HIV-associated Dementia (HDA) refers to HAND in its most severe form, where there is an inability to complete daily tasks independently.
Aetiology[edit | edit source]
HAND is a caused by direct effects of the HIV infection, independent of opportunistic infections.
Possible risk factors for HAND[1]:
- Advanced age
- Advanced WHO clinical stage
- Low CD4 count
- Anaemia
Clinical Presentation[edit | edit source]
Pre-ART HAND: psychomotor slowing - inattention, slow thinking, forgetfulness, unsteady gait, tremor, social withdrawal[1]
Post-ART HAND: more cortical involvement - impaired learning ability, memory executive function and extrapyramidal motor features[1]
Outcome Measures[edit | edit source]
- International HIV Dementia Scale (IHDS): Measures motor speed, psychomotor speed and learning, registration and memory; a score of <10 is regarded to be indicative of HAND, but poor sensitivity and specificity means that this test can not be used in isolation.[1]
Management[edit | edit source]
The most important strategy is to start ART as early as possible (which also implies early detection of HIV infection). Other strategies aimed at reducing inflammation - such as methotrexate, statins and antiepileptic medication - do not seem to have significant effects.[1]
ART[edit | edit source]
Early initiation of ART helps to prevent HAND in PLWH. In patients who already present with HAND, some improvement may occur once ART is initiated, but these improvements usually plateau after 9-months on ART. Many patients affected by HAND will experience persistence of symptoms.
Combined ART regimes with better central nervous system penetration can help to prevent HAND.
