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 …
There are several reasons why early recognition of cognitive impairment is important: People with HIV with cognitive impairment have been shown to be less adherent to HIV medication regimes (33-34). This may lead to drug-resistant HIV, resulting in their current medication regime becoming ineffective (20-21). Morbidity and mortality can then be affected as the person …
Regularly review the PLHIV – annual assessment is recommended. Ask the PLHIV questions about changes they may have noticed. Be aware of risk factors for HAND and other general cognitive impairment. Identify, reduce, and treat preventable cognitive risk factors including: smoking reduce cholesterol and triglycerides. treat hypertension, diabetes, HCV. reduce alcohol intake, reduce or cease …
Cognitive impairment continues to represent substantial personal, societal, and economic burdens and may place an increasing burden on Australian resources, especially as PLHIV age. Early recognition and treatment are paramount and can have a positive impact on quality of life and health outcomes for those living with HIV.
Alford, K., Daley, S., Banerjee, S. et al. “A fog that impacts everything”: a qualitative study of health-related quality of life in people living with HIV who have cognitive impairment. Qual Life Res 31, 3019–3030 (2022). https://doi.org/10.1007/s11136-022-03150-x del Palacio M, Alvarez S, Munoz-Fernandez, MA. HIV-1 infection and neurocognitive impairment in the current era. Rev Med Virol 2012; 22(1): 33-45, …