What is HIV-Associated Neurocognitive Disorder?

Are there changes in your loved one's memory, thinking, or behavior? Neurological changes can be scary with HIV patients. When cognitive changes are apparent, it can introduce new worries. HIV may have affected your loved one's memory and behavior. What can you do to help?

What is HIV-associated Neurocognitive Disorder?

HIV-associated Neurocognitive Disorder (HAND) refers to a spectrum of cognitive, motor, and/or behavioral impairments caused by HIV infection affecting the brain. It ranges from asymptomatic neurocognitive impairment to more severe forms like HIV-associated dementia, making it hard to focus, remember things, or make decisions.

Family caregivers may recognize common dementia-related symptoms. Early diagnosis and antiretroviral therapy are crucial for managing HAND symptoms and progression.

Causes of HIV-associated Neurocognitive Disorder

While HIV-associated dementia can affect the brain, some cognitive issues may have other causes, like depression or medication side effects.

Several factors influence the development of HAND, making it hard to predict who will get it: 

• HIV Infection: The virus can harm brain cells and affect cognitive function.
• Adherence to treatment: Not taking HIV medications regularly increases the risk of HAND. Family caregivers can monitor medicines to keep their loved ones healthy.
• Age: Older adults with HIV are more likely to develop HAND.
• Other Illnesses: Having other health problems can worsen HAND.

Opportunistic infections

In the past, infections that took advantage of a weakened immune system (opportunistic infections) contributed to HAND. With effective HIV treatment, these severe forms of dementia are less common.

Clinical features and diagnosis

HAND ranges from milder forms of cognitive dysfunction (asymptomatic neurocognitive impairment - ANI) with no noticeable symptoms but problems on thinking tests to severe dementia (HIV-associated dementia - HAD).

Spectrum of cognitive impairment

HAND, or HIV-associated neurocognitive disorders, includes many cognitive impairments in patients with HIV. These range from mild, such as asymptomatic neurocognitive impairment (ANI), where patients don't show noticeable cognitive dysfunction but might experience difficulties on cognitive tests, to severe dementia, known as HIV-associated dementia (HAD). 

The spectrum of HAND significantly impacts patients' daily functioning, including memory, attention, and decision-making abilities.

With advancements in HIV treatment and care, there is a growing focus on addressing the neurological aspects of HIV infection, including research into effective interventions to lessen the impact of HAND. 

Understanding the degrees of mental impairment within the spectrum of HAND helps doctors provide tailored support and interventions for a better quality of life.

Diagnostic criteria

Diagnosing HIV-associated Neurocognitive Disorder (HAND) involves a comprehensive assessment, including a detailed medical history, neurological examination, and neuropsychological testing to evaluate cognitive functions such as memory, attention, and motor skills.

Additionally, laboratory tests to rule out other potential causes of cognitive impairment and imaging studies like MRI or CT scans may be used to assess brain abnormalities.

Clinical criteria and standardized tools, such as the International HIV Dementia Scale (IHDS), may also be used to identify and classify the severity of HAND.

The IHDS consists of three simple tests:

1. Timed finger tapping: The patient is asked to alternately tap the first and second fingers of their non-dominant hand as quickly as possible for 10 seconds. This assesses motor speed and coordination.
2. Timed alternating hand sequence: The patient is instructed to perform a sequence of movements (clench fist, lay palm flat, and put palm side down on a flat surface) with their non-dominant hand as quickly as possible for 10 seconds. This evaluates psychomotor speed.
3. Recall of four words: The patient is given four words to remember and then asked to recall them after a brief distraction, which measures memory.

Each test is scored, and the total score ranges from 0 to 12. A score of 10 or less indicates possible HIV-associated cognitive impairment, warranting further evaluation. The IHDS is valued for its simplicity, speed, and effectiveness in identifying individuals needing more comprehensive neuropsychological testing.

Pathophysiology of HIV-associated Neurocognitive Disorder

HIV can wreak havoc on the brain in several ways. The virus itself invades and damages brain cells. This, along with the body's inflammatory response to HIV, can lead to cell death and decreased functioning. HIV causes impairment in healthy brain cells, affecting thinking and behavior. 

Glial cell damage

Glial cells keep everything connected, fueled, and cleaned up. When HIV damages these glial cells, it disrupts these vital services. Messages get lost, things slow down, and the body has trouble functioning.

There are a few ways HIV can cause this damage. Sometimes, the virus directly infects some glial cells, making them sick and unable to do their jobs. Other times, the body's fight against HIV creates a messy situation in the brain, harming both neurons and glial cells.

Medications control HIV and prevent impairment. However, some memory problems might still linger. Talk to their physician if you notice your loved one struggling to remember things.

Testing helps healthcare professionals understand what's going on. Researchers are also working hard to learn more about how to protect the brain's support system and improve memory in people with HIV.

Treatment of HIV-associated Neurocognitive Disorder

Managing HAND requires a multi-faceted approach to control the underlying HIV infection and alleviate cognitive symptoms. The cornerstone of HAND treatment is the consistent use of antiretroviral therapy (ART), which reduces the viral load in the body and has been shown to improve cognitive function over time.

While there is currently no specific medication that directly targets HAND symptoms, ongoing research continues to explore new therapeutic options. Meanwhile, several strategies can help manage the cognitive and behavioral challenges associated with HAND:

• Memory aids: Tools such as planners, calendars, and sticky notes can help organize daily tasks and improve memory. Setting reminders and creating routines can also help patients stay on track with their medication schedules and appointments.
• Exercise programs: Regular physical activity has been shown to enhance mood, reduce anxiety, and improve cognitive functions. Tailored exercise programs that include aerobic and resistance training can be particularly beneficial.
• Counseling and support: Engaging with a counselor or therapist can provide patients with coping strategies to deal with the emotional and psychological impact of HAND. Support groups and peer networks can also offer valuable encouragement and practical advice.
• Cognitive rehabilitation: Cognitive rehabilitation therapies, including cognitive training exercises and neurofeedback, can help improve specific cognitive deficits.
• Healthy lifestyle choices: Maintaining a nutritious diet, ensuring adequate sleep, and avoiding substances that can impair cognitive function, such as alcohol and recreational drugs, are important for overall brain health.
• Social engagement: Staying socially active and participating in activities can provide mental stimulation and reduce feelings of isolation.

Preventing HIV-related neurological complications

As people with HIV live longer, managing HAND is necessary for their overall care, especially in geographic areas with limited resources.

• Early diagnosis and treatment of HIV: Prevent or slow the progression of HAND.
• Research on treatments: Scientists are looking for ways to protect brain cells in people with HIV.
• Supportive care: Help a care recipient with HAND stay engaged in activities and maintain social connections

A note from Givers

We understand the challenges of caring for someone with HIV-associated Neurocognitive Disorder. There are programs available that can provide financial assistance to caregivers, such as Structured Family Caregiving or other Medicaid waivers. These programs offer stipends, respite care, and additional resources to ease the financial burden and support you in providing the best care. Use our matching tool or contact us to learn more about options for which you might be eligible.