Improvement of HIV-associated neurocognitive disorders after antiretroviral therapy intensification: the Neuro+3 study

2020 ◽  
Author(s):  
Gilles Force ◽  
Idir Ghout ◽  
Jacques Ropers ◽  
Guislaine Carcelain ◽  
Dhiba Marigot-Outtandy ◽  
...  
Keyword(s):  
Linear Regression Analysis ◽  
Neurocognitive Disorders ◽  
Asymptomatic Neurocognitive Impairment ◽  
Cognitive Improvement ◽  
Drug Classes ◽  
Multivariable Linear Regression Analysis ◽  
Cns Penetration ◽  
Cd4 Lymphocyte ◽  
Cns Penetration Effectiveness ◽  
Hiv Associated Neurocognitive Disorders

Abstract Objectives Despite the effectiveness of antiretroviral (ARV) therapy to control HIV infection, HIV-associated neurocognitive disorders (HAND) remain frequent. The Neuro+3 study assessed the cognitive improvement associated with ARV intensification based on increased CNS penetration effectiveness (CPE) scoring ≥+3 and total CPE score ≥9. Methods Thirty-one patients, aged 18–65 years, with confirmed diagnosis of HAND and effective ARV therapy were included. The cognitive improvement was measured using Frascati three-stage classification and global deficit score (GDS) after 48 and 96 weeks of ARV intensification. Ultrasensitive HIV-RNA, neopterin, soluble CD14, CCL2, CXCL10, IL6, IL8 and NF-L were measured in plasma and cerebrospinal fluid at Day 0 (baseline), Week 48 (W48) and W96. Results The intensified ARV was associated with a median (IQR) CPE score increase from 6 (4–7) at baseline to 10 (9–11). From baseline to W96, the median (IQR) GDS decreased from 1.4 (0.8–2.2) to 1.0 (0.6–2.0) (P = 0.009); HAND classification improved from 2 to 1 HIV-associated dementia, 22 to 8 mild neurocognitive disorders, 7 to 17 asymptomatic neurocognitive impairment and 0 to 5 patients without any neurocognitive alterations (P = 0.001). In multivariable linear regression analysis, GDS improvement at W96 was significantly associated with CPE score ≥9 after intensification (P = 0.014), CD4 lymphocyte increase at W48 (P < 0.001) and plasma CXCL10 decrease at W96 (P = 0.001). Conclusions In patients with HAND, a significant cognitive improvement was observed after the ARV intensification strategy, with a higher CPE score. Cognitive improvement was more often observed in the case of a switch of two drug classes, arguing for better control of CNS HIV immune activation.

scholarly journals Neuroimaging of HIV-associated neurocognitive disorders

2015 ◽  
Vol 9 (4) ◽  
pp. 380-384 ◽  
Author(s):  
Michel Elyas Jung Haziot ◽  
Silas Pereira Barbosa Junior ◽  
José E. Vidal ◽  
Francisco Tomaz Meneses de Oliveira ◽  
Augusto César Penalva de Oliveira
Keyword(s):  
Cognitive Impairment ◽  
Neurocognitive Disorders ◽  
Classification Criteria ◽  
Neurocognitive Disorder ◽  
Aids Patients ◽  
Asymptomatic Neurocognitive Impairment ◽  
Associated Diseases ◽  
Broad Term ◽  
Cns Penetration ◽  
Hiv Associated Neurocognitive Disorders

ABSTRACT A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD) for the most severe cases. HIV-associated neurocognitive disorders (HAND) is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.

scholarly journals HIV-associated neurocognitive disorders

2011 ◽  
Vol 17 (4) ◽  
pp. 4 ◽  
Author(s):  
Zahir Vally
Keyword(s):  
South African ◽  
Test Performance ◽  
Relevant Literature ◽  
Neurocognitive Disorders ◽  
Information Processing Speed ◽  
Psychomotor Slowing ◽  
Asymptomatic Neurocognitive Impairment ◽  
Assessment Techniques ◽  
Advanced Stages ◽  
Hiv Associated Neurocognitive Disorders

HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIV-associated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND, which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed, learning and memory, attention and working memory, speech and language, executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations, possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations, as well as the development of relevant norms for comparison of test performance data.

scholarly journals Optimal treatment of HIV-associated neurocognitive disorders: myths and reality. A critical review

2019 ◽  
Vol 6 ◽  
pp. 204993611983822 ◽  
Author(s):  
Anastasia Bougea ◽  
Nikolaos Spantideas ◽  
Petros Galanis ◽  
George Gkekas ◽  
Thomas Thomaides
Keyword(s):  
Clinical Trials ◽  
Reverse Transcriptase ◽  
English Language ◽  
Antiretroviral Treatment ◽  
Neurocognitive Disorders ◽  
Strand Transfer ◽  
Asymptomatic Neurocognitive Impairment ◽  
Neuronal Markers ◽  
System Combination ◽  
Hiv Associated Neurocognitive Disorders

Background: The aim of this study was to review the clinical data on the effectiveness of the pharmacotherapy of HIV-associated neurocognitive disorders (HANDs). Methods: A literature search of PubMed was performed (from January 1996 to October 2018) using the terms: ‘HIV-associated neurocognitive disorders’, ‘HIV-associated dementia’, ‘mild neurocognitive disorder (MND)’, ‘asymptomatic neurocognitive impairment (ANI)’, ‘adjuvant therapies’, ‘antiretroviral treatment (cART)’, ‘neurotoxicity’, ‘cART intensification’, ‘fluid markers’, ‘cerebrospinal fluid’, ‘protease inhibitors’, ‘nonnucleoside reverse transcriptase inhibitor’, ‘nucleoside reverse transcriptase inhibitors’, and ‘integrase strand transfer inhibitors’. Additional references were identified from a review of literature citations. All English language clinical studies of adjunctive therapies and neuronal markers were selected in order to evaluate a closer relationship between the early involvement and the onset of cognitive decline. We identified 407 relevant studies, of which 248 were excluded based on abstract analysis. Finally, we analyzed 35 articles, organizing the results by cART, adjuvant and neuronal markers (total of 7716 participants). Results: It is important to inform clinicians about the importance of accurate phenotyping of HIV patients, incorporating an array of markers relevant to HAND pathophysiology, in order to assess the individual’s risk and potential response to future personalized antiretroviral treatment Conclusion: So far, no clinical trials of HAND therapies are effective beyond optimal suppression of HIV replication in the central nervous system. Combination of validated neuronal markers should be used to distinguish between milder HAND subtypes and improve efficiency of clinical trials, after strict control of confounders.

HIV-Associated Neurocognitive Disorders

2017 ◽  
Author(s):  
Joshua Alexander ◽  
David J Croteau ◽  
Ronald J Ellis
Keyword(s):  
Cognitive Impairment ◽  
Antiretroviral Therapy ◽  
Neurocognitive Disorders ◽  
Virologic Suppression ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Antiretroviral Adherence ◽  
Combined Antiretroviral Therapy ◽  
Neurocognitive Decline ◽  
Hiv Associated Neurocognitive Disorders

Three subclassifications of HIV Associated Neurocognitive Disorders (HAND) can be delineated: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). HAND occurs in about half of patients infected with HIV. All forms, including ANI and MND, are associated with unemployment and reduced antiretroviral adherence, which can lead to loss of virologic suppression, further neurocognitive decline, and systemic illness. Fortunately, combined antiretroviral therapy can stabilize and even reverse cognitive impairment.

scholarly journals HIV-Associated Neurocognitive Disorders: A Global Perspective

2017 ◽  
Vol 23 (9-10) ◽  
pp. 860-869 ◽  
Author(s):  
Rowan Saloner ◽  
Lucette A. Cysique
Keyword(s):  
Hiv Infection ◽  
Biomarker Discovery ◽  
Longitudinal Design ◽  
Neurocognitive Disorders ◽  
Global Perspective ◽  
Global Studies ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
The Rich ◽  
Hiv Associated Neurocognitive Disorders

AbstractThe 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)

Neurological Effects of HIV Infection

2019 ◽  
pp. 413-432
Author(s):  
Rodrigo Hasbun ◽  
Richard Dunham ◽  
Rituparna Das ◽  
Karen Nunez-Wallace ◽  
Lydia J. Sharp ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Severe Form ◽  
Viral Escape ◽  
Neurocognitive Disorder ◽  
The Central Nervous System ◽  
Hiv Associated Neurocognitive Disorder ◽  
Cns Penetration ◽  
Neurological Effects ◽  
Cns Penetration Effectiveness ◽  
Hiv Associated Neurocognitive Disorders

Discuss the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders. • CD8+ T cell encephalitis has been described as a severe form of HIV-associated neurocognitive disorder (HAND). • The central nervous system (CNS) penetration effectiveness score has been correlated with cerebrospinal fluid (CSF) viral escape....

scholarly journals Operationalization of the updated diagnostic algorithm for classifying HIV-related cognitive impairment and dementia

2010 ◽  
Vol 23 (5) ◽  
pp. 835-843 ◽  
Author(s):  
J. M. Foley ◽  
M. J. Wright ◽  
A. L. Gooding ◽  
M. Ettenhofer ◽  
M. Kim ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Executive Functioning ◽  
Functional Decline ◽  
Diagnostic Algorithm ◽  
Neurocognitive Disorders ◽  
Cognitively Impaired ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Global Cognition ◽  
Hiv Associated Neurocognitive Disorders

ABSTRACTBackground: This study applies the updated HIV-Associated Neurocognitive Disorders (HAND) diagnostic algorithm.Methods: Participants were 210 HIV-infected-adults, classified using proposed HAND criteria: HIV-Associated Dementia (HAD), Mild Neurocognitive Disorder (MND), Asymptomatic Neurocognitive Impairment (ANI).Results: The algorithm yielded: normal = 32.8%, ANI = 21.4%, MND = 34.3%, and HAD = 11.4%. Normal participants performed superior to HAND-defined participants on cognition, and HAD participants performed more poorly on global cognition and executive functioning. Two distinct subgroups of interest emerged: (1) functional decline without cognitive impairment; (2) severe cognitive impairment and minimal functional compromise.Conclusions: The algorithm discriminates between HIV-infected cognitively impaired individuals. Diagnosis yields two unique profiles requiring further investigation. Findings largely support the algorithm's utility for diagnosing HIV-cognitive-impairment, but suggest distinct subsets of individuals with discrepant cognitive/functional performances that may not be readily apparent by conventional application of HAND diagnosis.

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