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
