HIV and dementia

Question 1

what is HAND?

Answer 1

HIV associated neurocognitive disorders

three further subtypes

HIV 1 ANI- associated asymptomatic neurocognitive impairment

hiv1- MND associated mild neurocognitive disorder

HAD- HIV assoaicted dementia

Question 2

what is ANI?

Answer 2

acquired impairment in at least two domains ( 1sd below age and education norms)

functional impairment: none

Question 3

what is MND (HAND)

Answer 3

neuropsychological profile: acquired impairment in at least two domains

functional impairment:
mild interference in functioning

a) self reported

or

b) observations by others

Question 4

what is HAD

Answer 4

neuropsychological profile:

Acquired impairment in at least two domains with at least two domains with severe impairment (<2SDs)

functional impairment:

Marked interference with daily functioning (work, home, social activities)

Question 5

what is the epidemiology of HAD

Answer 5

before HAART 21 per 1000

after HAART 10.5 per 1000

the multicentre AIDS cohort study (2001)

Question 6

what are the symptoms of HAD

Answer 6

generally develop over weeks to month in following domains:

cognition:

decreases attention, forgetfulness,
slowing of thought processes
global dementia
confusion, disorientation
organic psychosis

motor:

unsteady gait
clumsiness
tremor
leg weakness
loss of coordination/impaired handwriting 

behavior

social withdrawal
apathy
personality change
agitation
hallucinations

other:
headaches
generalized seizures
ataxia

Question 7

describe invesigation for HAD

Answer 7

drug history
mood/anxiety

exclude other causes of CI in HIV
(infections ie toxo/ vascular)

CNS penetration effectiveness score

T2 mri

Question 8

describe treatment for HAD

Answer 8

reduce viral load and activity in CNS

treamtent primarilty cART/HAART

abacivit, zidovudine, nevirapine as best CNS pentration

supportive

prevention

Question 9

what is the criteria for ANI according to the frascatti criteria 2007

Answer 9

performance at least 1 SD below mean

in at least two domains

at least five domains needs to be examined

impairment does not occur solely as a result of delerium

Question 10

what is a caveat of the frascatti criteria?

Answer 10

using AAN criteria over 90% of minorities diagnosed compaired to 78% caucasians

in healthy subjects

33% african americans vs 15% white were considered congitively impaired

Question 11

cART/HAART and HIV dementia

Answer 11

some antiretrovirals aren’t very good at penetrating CNS

poor CPE (CNS penetration effectiveness)

better neurocongitivve functioning measures with higher CPE cART drugs (smurzynski et al 2011)

Question 12

what is one caveat of cART and HAND?

Answer 12

he persistent high prevalence of less severe forms of HAND, together with some evidence suggesting progressive cognitive dysfunction despite adequate suppression of HIV RNA in plasma and CSF, has raised the possibility of cART neurotoxicity.

a study on rats found that of 15 antiretrovirals tests on rat neurons

only one didn’t cause mitochondrial dysfunction