Denise Cummins: Sydney District Nursing, Sydney Local Health District Summary This section explores key issues for nurses in relation to cognitive impairment and people living with HIV (PLHIV): Background Examples of dementia HIV associated neurocognitive disorder (HAND) Screening, diagnosis, and predictors of HAND Signs and symptoms of HAND Treatment of HAND Strategies for support of cognitive …
In addition to HAND, PLHIV may be at risk of developing other forms of dementia. Dementia is a term used to describe a group of conditions characterised by gradual impairment of brain function, which may impact cognition, memory, mobility, speech, personality, and behaviour. The most common form of dementia is Alzheimer’s disease; it is also …
HIV-associated neurocognitive disorder (HAND) is an umbrella term used to describe neurodegenerative disease caused by human immunodeficiency virus (HIV)-1 infection and may affect more than 30% of PLHIV (16) regardless of virological suppression (17). The central nervous system acts as a reservoir for HIV with neuronal damage occurring both at the time of initial HIV …
It is recommended that PLHIV be questioned and screened annually about any changes to cognition or memory decline (23). If any symptoms are identified, HIV neurology review should be considered. In the short-term strategies should be discussed with the person to treat symptoms. If the person is then diagnosed with cognitive impairment the person should …
Studies suggest predictors of HAND include history of AIDS-defining central nervous system (CNS) disease (14), other CNS disease (14), low T cell nadir (30), longer duration of HIV infection (31), drug and alcohol use (31), and hepatitis C infection (32). Additionally, the risk of HAND increases as CD4+ counts decline below 350cells/uL and with higher plasma viral load …
Comorbidities often appear earlier and progress faster in PLHIV. Vascular risk factors such as smoking, hypertension, diabetes, hypercholesterolaemia and hyperlipidaemia should be considered, as they would in the non-HIV population. Other considerations include impaired renal function, cytomegalovirus, frailty, chronic pulmonary disease; the gut biome may also be involved (4,35).
Signs and symptoms (S&S) of HAND experienced by PLHIV that can indicate changes in cognition may be a new behaviour (e.g. poorer memory). S&S may be so subtle that they are missed or the PLHIV may attribute the changes to something else, such as being tired, stressed, or busy. If the person has always misplaced …
Ask the person to tell you about any changes they have noticed in themselves. Are you slower in your thinking than you used to be? Are you more forgetful than you used to be? Do you have any difficulty paying attention (e.g. following conversations or the plot of a TV show or movie)? Is it …
Caregivers and loved ones can provide unique insight and collateral history into the person’s behaviour and, if available, are important to include in the discussion. Ask them if they have noticed any changes. Have you noticed any changes in the person’s behaviour? Is the person more forgetful? Has his or her personality changed? Is the …
HIV antiretroviral medication is the cornerstone to treat cognitive impairment (17). Early and continuous viral suppression with ART is associated with improved performance on neuropsychological testing (37). But medication adherence can be difficult for someone experiencing S&S of HAND. When treatment fails and virologic rebound occurs, cognitive function deteriorates. More than 30% of PLHIV may develop …
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