HIV-Associated Neurocognitive Disorders: A Global Perspective

Abstract

The present review on HIV-associated neurocognitive disorders (HAND) provides a worldwide overview of studies that have investigated the rate and neuropsychological (NP) profile of HAND research since the inception of the 2007 HAND diagnostic nomenclature. In the first part, the review highlights some of the current controversies around HAND prevalence rates. In the second part, the review critically assesses some solutions to move the field forward. In the third part, we present the cross-sectional NP profile in non-Western HIV+ cohorts and in relation to Western cohorts’ findings. The adopted global perspective highlights the successful expansion of NP studies in HIV infection to culturally diverse low- to medium-income countries with high HIV burden. These studies have produced interestingly similar rates of HAND whether patients were naïve or treated and/or virally suppressed compared to the rich income countries where the NP research in NeuroHIV has originated. The perspective also demonstrates that globally, the group which is the most representative of the HIV epidemic, and thus at risk for HAND are persons with chronic HIV infection and survivors of past immunosuppression, while in relative terms, those who have been treated early with long-term viral suppression represent a minority. In the last part, we present a review of the naturalistic longitudinal NP global studies in HIV+cohorts, discuss the role of longitudinal design in solving issues around the question of asymptomatic neurocognitive impairment, and the question of biomarker discovery. Finally, we conclude by calling for greater methods and data harmonization at a global level. (JINS, 2017, 23, 860–869)

Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review

“…According to Frascati criteria [13], HAND is classified into three stages: Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND), and HIV-associated dementia (HAD), and requires the use of demographicallycorrected test scores as well as functional status and the exclusion of non-HIV causes of impairment. HAND, especially the ANI subtype still persists among PLHIV between 20-50% even in the cART era [14][15][16][17][18].…”

Smaller limbic structures are associated with greater immunosuppression in over 1000 HIV-infected adults across five continents: Findings from the ENIGMA-HIV Working Group

“…However, HIVrelated comorbidities, including symptoms of brain dysfunction, remain common even in treated HIV+ individuals. 1,2 The prevalence of neurocognitive impairment (NCI) in HIV+ populations varies across studies: some reports suggest that cognitive difficulties are present in nearly half of HIV+ individuals, but other studies report less than 20% are affected. 3 This variability may reflect heterogeneous viral-host dynamics and cART treatment status.…”

“…In studies using standard neuropsychological assessments and appropriate normative data, there is robust evidence that even mild NCI can interfere with the capacity to perform instrumental activities of daily living (IADLs). 2 Plasma viral load (VL) and CD4+ T-cell count are two biomarkers universally used to monitor immune function and treatment response. These are also the most consistently available clinical markers in human studies of HIV, but the degree to which they capture CNS impairment is not fully understood.…”

Childhood trauma interacts with ApoE to influence neurocognitive function in women living with HIV

“…HIV crosses the blood-brain barrier early in the course of infection, where it can foster an inflammatory milieu with potentially neurotoxic effects (Ene 2018). Despite the success of combined antiretroviral therapy (cART) in reducing HIV-related morbidity and mortality, milder forms of HAND predominate comprising a mixed pattern of both cortical and subcortical features with varying degrees of functional impairment in activities of daily living (Saloner and Cysique 2017). Recent estimates suggest that as many as 50% of people living with HIV are affected by milder forms of HAND (Clifford and Ances 2013;Saloner and Cysique 2017).…”

“…Despite the success of combined antiretroviral therapy (cART) in reducing HIV-related morbidity and mortality, milder forms of HAND predominate comprising a mixed pattern of both cortical and subcortical features with varying degrees of functional impairment in activities of daily living (Saloner and Cysique 2017). Recent estimates suggest that as many as 50% of people living with HIV are affected by milder forms of HAND (Clifford and Ances 2013;Saloner and Cysique 2017). This is particularly concerning given that HAND is also associated with unemployment, reduced adherence to antiretroviral medication and poorer quality of life, thus heavily impacting affected individuals as well as broader society (Heaton et al 2004;Woods et al 2011).…”