HIV Associated Neurocognitive Disorders (HAND)

Synonyms:

HIV associated dementia HAD, formerly Subacute or Chronic HIV encephalitis a.k.a. AIDS dementia complex formerly AIDS encephalopathy/AIDS encephalitis

Diagnosis:

Acquired impairment in at least 2 cognitive domains:

  • Learning, information processing speed, attention/concentration
  • +Marked impairment of ADLS
  • +No delirium
  • +No other cause for dementia
  • Other features & tests:
    • Limb incoordination, gait ataxia, abnormal smooth pursuit & saccades

Findings on Investigations:

CSF: may be normal, mild leukocytosis, mildly increased protein.
MRI: may be normal, diffuse white matter changes may occur

Pathology:

Multiple patterns may occur
HIV encephalitis: multifocal multinucleated giant cells in white matter & deep grey matter, with rarefaction of white matter (pallor & decreased myelin), and some inflammatory cells (microglial nodules, macrophages, scant lymphocytes) with astrocytosis
HIV leukoencephalopathy: diffuse white matter lesions, with rarefaction of white matter (pallor & decreased myelin) & loss of axons (beta amyloid precursor protein)
Diffuse Poliodystrophy= wasting of grey matter: diffuse astrocytosis & microglia in the cortex with neuronal loss.

HIV associated mild neurocognitive disorder MND

Diagnosis:

Acquired impairment in at least 2 cognitive domains:

  • Verbal/language, information processing speed, attention/working memory, abstraction/executive memory (learning/recall), sensory-perceptual, motor skills
  • +Mild decline (self report or observed) in functioning (home, work or social)
  • +No delirium or dementia
  • +No other cause

HIV associated asymptomatic neurocognitive impairment ANI

Diagnosis:

Deficits in neuropsychological testing
+Cognitive decline doesn’t lead to impairment of ADLS
+No delirium or dementia
+No other cause

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