Abstract
HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIV-associated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND, which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed, learning and memory, attention and working memory, speech and language, executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations, possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations, as well as the development of relevant norms for comparison of test performance data.
Highlights
HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND)
South Africa continues to be home to the world’s largest population of people living with HIV.[1]. In developed countries such as the USA, the introduction of highly active antiretroviral therapy (HAART) as the mainstay of HIV treatment has resulted in impressive reductions in the incidence of severe HIV-associated neurocognitive disorders (HAND) and impacted favourably on survival rates in patients with HIV infection.[2]
The revisions emphasised that documented neurocognitive disturbance was an essential feature in the diagnosis of HAND, and specified more precise criteria for three syndromes: (i) asymptomatic neurocognitive impairment (ANI); (ii) HIV-associated mild neurocognitive disorder (MND); and (iii) HIV-associated dementia (HAD)
Summary
The diagnostic nosology for HAND was revised and amended in 2007 using recommendations from the US National Institutes of Health working group.[5] The revisions emphasised that documented neurocognitive disturbance was an essential feature in the diagnosis of HAND, and specified more precise criteria for three syndromes: (i) asymptomatic neurocognitive impairment (ANI); (ii) HIV-associated mild neurocognitive disorder (MND); and (iii) HAD. These syndromes are discussed in turn below. The prevalence, on the other hand, has increased due to the increased survival of HIV-infected patients resulting from the widespread use of HAART.[4]
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