HIV Flashcards
What is the definition of HIV associated neurocognitive disorder?
Changes to memory, concentration, attention and motor skills common in patients with HIV
(When not attributed to another alternate cause)
What are the three types of HAND?
- Asymptomatic neurocognitive impairment
- Mild neurocognitive disorder
- HIV associated dementia (AIDS dementia complex)
What is the diagnostic criteria for asymptomatic neurocognitive impairment in HIV?
- Acquired impairment in neuropsychiatric testing in at least 2 cognitive domains at least 1 SD below mean
- No symptomatic or observable functional impairment
- Not explained by other comorbidities or delirium
What is the diagnostic criteria for mild neurocognitive disorder in HIV?
- Acquired impairment in neuropsych testing in at least 2 cognitive domains at least 1 SD below mean
- Mild symptomatic or functional impairment
- Not due to other comorbidities or delirium
What is the diagnostic criteria for HIV associated dementia?
- Acquired impairment in neuropsychiatric testing in at least 2 cognitive domains at least 2 SD below mean
2.Marked interference with ADLs - Not due to other comorbidities or delirium
What are current criticisms of the Frascati criteria for HAND?
- Overestimate disease burden
- Ambiguity around mechanisms
- Based on cognitive tests alone which may be inappropriate based on education, SES
What areas of the brain are affected in HAND?
Basal ganglia
Nigrostriatal
Diffuse neuronal loss - frontal and temporal
What risk factors are associated with HAND?
HIV related
1. Low nadir CD4
2. Period of severe immunosuppression
Comorbidities
1. Older age
2. DM
3. HTN
4. COPD
5. Frailty
6. Depression
7. Neuropathic pain
8. Vascular disease
9. Metabolic abnormalities
What are differences between HIV associated dementia and AD?
- HAD more static
- Subacute progressive decline more likely AD
- HIV patients don’t have higher incidence of AD
What type of cognitive dysfunction occurs in HAD?
- Executive dysfunction
- Attention-concentration
- Impaired psychomotor speed
- Depression
- Apathy
- Paranoia/hallucinations
What type of testing should you use for HAD?
MOCA most practical
MMSE doesn’t account for executive
HIV Dementia Scale and International Dementia Scale (not highly Sn for mild impairment)
What investigations should you do for patient with HAD?
CD4 count, viral load
Metabolic - LFT, glucose, B12, folate, TSH, syphilis, hep C
Imaging - MRI
LP for other causes - CJD, EBV, CMV, syphilis, cryptococcus
What CSF findings will you see in HAD?
Elevated protein
Elevated ratio of albumin CSF:blood
HIV RNA level > plasma
What is the treatment for HAD?
ART prevents development
Cognitive improvement
Impact on milder forms unclear
Can change regimen if already on
How does age affect HIV associated dementia?
- Increase age is significant risk factor for HAD
- More likely to have medical comorbidities = inc risk HAD
- Older HIV infected adults may experience age related cognitive decline sooner
- May have competing neurodegenerative disorders
- More likely to have polypharmacy which can interact with ART
- Two ART with highest CNS penetration have poor sfx in older adults
