HIV-Associated Neurocognitive Disorder (HAND)



Definition:

HIV-Associated Neurocognitive disorders categories:

• Asymptomatic neurocognitive impairment

• Mild neurocognitive impairment

• HIV dementia



Pathophysiology:

HIV frequently compromises the integrity of the blood-brain barrier (BBB), and infects the CNS in the early stages of infection

• HIV is neuroinvasive - HIV invades mononuclear cells in the CNS

	○ Infected cells -> microglial activation -> diffuse myelin loss -> neuronal death -> astroglial proliferation

• ARVs can have low penetrance through the blood-brain barrier



Classic HIV Encephalopathy Triad:

• Memory/psychomotor impairment

• Depressive symptoms

• Movement disorders

	○ This presentation is similar to PML, but MRI will show symmetric bilateral white matter lesions that are less well-defined than PML lesions, which are usually asymmetric.



Diagnosis:

MRI Findings:

• Rule out infectious etiologies and PML (JC virus)

Brain parenchymal loss:

• Increased CSF fluid

• Decrease in striatal gray matter volume

• Decrease in cerebral white matter volume

• Patchy areas of high signal intensity on T2-weighted and fluid-attenuated inversion recovery sequences with relative sparing of the subcortical white matter and posterior fossa structures.



Clinical Presentation:

The clinical syndrome of HAD comprises of a combination of:

• Cognitive

• Behavioral

• Motor dysfunction like gait disturbance and tremors

• While there is some individual variation, frequent manifestations include: inattention and reduced concentration, apathy and dulling of personality, psychomotor slowing, marked motor slowing and ataxia.

• Often presents after years of untreated HIV and with low CD4 counts.



Treatment:

• HAART treatment

• Cognitive impairment is often not fully reversible

• HAND is also associated with increased mortality among HIV patients



#HAND #HIV #Associated #neurocognitive #disorder #dementia #AIDS #Neurology