scholarly journals Risk Factors and Pathogenesis of HIV-Associated Neurocognitive Disorder: The Role of Host Genetics

2018 ◽  
Vol 19 (11) ◽  
pp. 3594 ◽  
Author(s):  
Ian Olivier ◽  
Ramón Cacabelos ◽  
Vinogran Naidoo
Keyword(s):  
Risk Factors ◽  
Immune Response ◽  
Human Genetics ◽  
Hiv Treatment ◽  
Specific Gene ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Host Genetics ◽  
Hiv Associated Neurocognitive Disorder

Neurocognitive impairments associated with human immunodeficiency virus (HIV) infection remain a considerable health issue for almost half the people living with HIV, despite progress in HIV treatment through combination antiretroviral therapy (cART). The pathogenesis and risk factors of HIV-associated neurocognitive disorder (HAND) are still incompletely understood. This is partly due to the complexity of HAND diagnostics, as phenotypes present with high variability and change over time. Our current understanding is that HIV enters the central nervous system (CNS) during infection, persisting and replicating in resident immune and supporting cells, with the subsequent host immune response and inflammation likely adding to the development of HAND. Differences in host (human) genetics determine, in part, the effectiveness of the immune response and other factors that increase the vulnerability to HAND. This review describes findings from studies investigating the role of human host genetics in the pathogenesis of HAND, including potential risk factors for developing HAND. The similarities and differences between HAND and Alzheimer’s disease are also discussed. While some specific variations in host genes regulating immune responses and neurotransmission have been associated with protection or risk of HAND development, the effects are generally small and findings poorly replicated. Nevertheless, a few specific gene variants appear to affect the risk for developing HAND and aid our understanding of HAND pathogenesis.

scholarly journals Prevalence and predictors of HIV-associated Neurocognitive Disorder in Ethiopians

2020 ◽  
Author(s):  
Mohammed Salahuddin ◽  
Md Dilshad Manzar ◽  
Hamid Yimam Hassen ◽  
Mihretu Ashuro ◽  
Aleem Unissa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vulnerable Groups ◽  
Binary Logistic Regression Analysis ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Cross Sectional ◽  
Targeted Screening ◽  
Independent Risk Factors ◽  
Hiv Associated Neurocognitive Disorder ◽  
Living With Hiv

Abstract Background Modern antiretroviral therapy has extended the life expectancies of people living with HIV; the prevention and treatment of their associated neurocognitive decline has remained a challenge. Consequently, it is desirable to investigate the prevalence and predictors of HIV-associated Neurocognitive Disorder (HAND) to help in targeted screening and disease prevention. Methods: Two hundred and forty-four people living with HIV were interviewed in a study using a cross-sectional design and International HIV Dementia scale (IHDS). Additionally, the sociodemographic, clinical and psychosocial characteristics of the patients were recorded. Chi-square and binary logistic regression analysis were used to determine the level of significance among the independent risk factors and probable HAND. Results The point prevalence of HAND was found to be 39.3%. Participants’ characteristics of being older than 40 years (AOR = 2.81 (95% CI; 1.11–7.15)), having a history of recreational drug use (AOR = 13.67 (95% CI; 6.42–29.13)), and being non-compliant with prescribed medications (AOR = 2.99 (95% CI; 1.01–8.87)) were independent risk factors for HAND. Conclusion The identification of predictors, some of which may be more closely related to the Ethiopian people living with HIV, may help in targeted screening of vulnerable groups during cART follow-up visits. This may greatly help in strategizing and implementation of the prevention program, more so, because: (i) HAND is an asymptomatic condition for considerable durations, and (ii) clinical trials of HAND therapies have been unsuccessful.

HIV-Associated Neurocognitive Disorders

2019 ◽  
pp. 27-60
Author(s):  
Jennifer E.  Iudicello ◽  
Erin E. Morgan ◽  
Mariam A. Hussain ◽  
Caitlin Wei-Ming Watson ◽  
Robert K. Heaton
Keyword(s):  
Differential Diagnosis ◽  
Neurocognitive Impairment ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Diagnostic Systems ◽  
Neurocognitive Performance ◽  
Everyday Functioning ◽  
Asymptomatic Neurocognitive Impairment ◽  
Age Related

Human immunodeficiency virus enters the central nervous system (CNS) early after systemic infection, and may cause neural injury and associated neurocognitive impairment through multiple direct and indirect mechanisms. An international conference of multidisciplinary neuroAIDS experts convened in 2005 to propose operationalized research criteria for HIV-related cognitive and everyday functioning impairments. The resulting classification system, known as the Frascati criteria, defined three types of HIV-associated neurocognitive disorder (HAND): asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD). Consideration of comorbid conditions that can influence neurocognitive performance, such as developmental disabilities, non-HIV forms of CNS compromise (neurological and systemic), severe psychiatric conditions, and substance use disorders, is essential to differential diagnosis. Since the introduction of combination antiretroviral therapy (ART), rates of severe HAND (i.e., HAD) have greatly declined, although the milder forms of HAND remain quite prevalent, even in virally suppressed people living with HIV (PLWH). Beyond ART, clinical management of HAND includes behavioral interventions focused on neurocognitive and functional improvements. This chapter covers a range of HAND-related topics, such as the neuropathological mechanisms of HIV-related CNS injury, assessment and diagnostic systems for neurocognitive and everyday functioning impairment in HIV, treatment and protective factors, aging with HIV, HAND in international settings, and ongoing challenges and controversies in the field. Future needs for progress with HAND include advances in early detection of mild cognitive deficits and associated functional impairment in PLWH; biomarkers that may be sensitive to its underlying pathogenesis; and differential diagnosis of HAND versus age-related, non-HIV-associated disorders.

scholarly journals Scaling Up Information Sharing on HIV-Associated Neurocognitive Disorder: Raising Awareness and Knowledge Among Key Stakeholders

SAGE Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 215824402110168
Author(s):  
Renato M. Liboro ◽  
Paul A. Shuper ◽  
Lori E. Ross
Keyword(s):  
Health Care ◽  
Information Sharing ◽  
Service Providers ◽  
Scale Up ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Public Health Informatics ◽  
Raising Awareness ◽  
Hiv Associated Neurocognitive Disorder ◽  
Hiv Aids

Although the majority of specialists and researchers in the field of HIV/AIDS are aware and knowledgeable about HIV-associated neurocognitive disorder (HAND) as a condition that affects as much as 50% of people living with HIV/AIDS (PLWH), research has documented that many health care and service providers who work directly with PLWH are either unaware of HAND or believe they do not know enough information about HAND to effectively support their clients experiencing neurocognitive challenges. Based on the findings of a qualitative study that interviewed 33 health care and service providers in HIV/AIDS services to identify and examine their awareness and knowledge on HAND, this article argues for utilizing a combination of Public Health Informatics principles; communication techniques, propagation strategies, and recognized approaches from Implementation and Dissemination Science; and social media and online discussion platforms, in addition to traditional Knowledge Mobilization strategies, to scale up information sharing on HAND among all relevant stakeholders. Increasing information sharing among stakeholders would be an important step to raising awareness and knowledge on HAND, and consequently, improving care, services, and support for PLWH and neurocognitive issues.

“I’m Just Forgetting and I Don’t Know Why”: Exploring How People Living With HIV-Associated Neurocognitive Disorder View, Manage, and Obtain Support for Their Cognitive Difficulties

2018 ◽  
Vol 28 (6) ◽  
pp. 859-872 ◽  
Author(s):  
Alexander R. Terpstra ◽  
Catherine Worthington ◽  
Francisco Ibáñez-Carrasco ◽  
Kelly K. O’Brien ◽  
Aiko Yamamoto ◽  
...  
Keyword(s):  
Health Care ◽  
Lived Experience ◽  
Health Care Professionals ◽  
Management Strategies ◽  
Well Being ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Cognitive Difficulties ◽  
Hiv Associated Neurocognitive Disorder ◽  
Living With Hiv

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.

scholarly journals Risk factors for symptomatic HIV ‐associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania

2020 ◽  
Vol 35 (10) ◽  
pp. 1198-1208
Author(s):  
Patrick Eaton ◽  
Thomas Lewis ◽  
Johanna Kellett‐Wright ◽  
Aidan Flatt ◽  
Sarah Urasa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neurocognitive Disorder ◽  
Hiv Associated Neurocognitive Disorder

Global prevalence and burden of HIV-associated neurocognitive disorder

Neurology ◽  
2020 ◽  
Vol 95 (19) ◽  
pp. e2610-e2621 ◽  
Author(s):  
Yunhe Wang ◽  
Moxuan Liu ◽  
Qingdong Lu ◽  
Michael Farrell ◽  
Julia M. Lappin ◽  
...  
Keyword(s):  
Data Extraction ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
Cd4 Cell Count ◽  
Hiv Associated Neurocognitive Disorder ◽  
Sub Saharan ◽  
High Level

ObjectiveTo characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.MethodsWe searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.ResultsOf 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).ConclusionsOur findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

scholarly journals Tryptophan, Neurodegeneration and HIV-Associated Neurocognitive Disorder

2010 ◽  
Vol 3 ◽  
pp. IJTR.S4321 ◽  
Author(s):  
Nicholas W.S. Davies ◽  
Gilles Guillemin ◽  
Bruce J. Brew
Keyword(s):  
Neurodegenerative Disease ◽  
Differential Expression ◽  
Inflammatory Cells ◽  
Kynurenine Pathway ◽  
Motor Neurone ◽  
Neurocognitive Disorder ◽  
Pathogenetic Role ◽  
Hiv Associated Neurocognitive Disorder ◽  
The Brain

This review presents an up-to-date assessment of the role of the tryptophan metabolic and catabolic pathways in neurodegenerative disease and HIV-associated neurocognitive disorder. The kynurenine pathway and the effects of each of its enzymes and products are reviewed. The differential expression of the kynurenine pathway in cells within the brain, including inflammatory cells, is explored given the increasing recognition of the importance of inflammation in neurodegenerative disease. An overview of common mechanisms of neurodegeneration is presented before a review and discussion of the evidence for a pathogenetic role of the kynurenine pathway in Alzheimer's disease, HIV-associated neurocognitive disorder, Huntington's disease, motor neurone disease, and Parkinson's disease.

scholarly journals 843. Targeted HIV Testing for Patients Hospitalized for COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S512-S512
Author(s):  
Michael D Virata ◽  
Merceditas Villanueva ◽  
Janet Miceli
Keyword(s):  
Risk Factors ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Treatment Algorithm ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Hiv Patients ◽  
Entire Study ◽  
Comorbidity Scores ◽  
Hiv Risk Factors

Abstract Background SARS-CoV-2 causes a severe respiratory illness known as COVID-19. Treatment options in the early portion of the COVID-19 pandemic included the use of antiretroviral agents i.e. protease inhibitors (PIs) such as lopinavir (LPV) that had been shown to have activity against the main proteases of SARS-CoV-2 in vitro but with very limited clinical data. Prior to the use of PIs, HIV testing would be indicated to ensure that patients who were not previously diagnosed with HIV would start appropriate HIV treatment. In this unique situation, HIV testing would be utilized not based on traditional HIV risk factors. Methods We performed a retrospective search from a specific systems database of patients admitted to Yale-New Haven Health System (YNHHS) with a diagnosis of COVID-19 infection. We identified a subset of patients who were HIV tested. Most were done prior to initiating PI treatment. Demographics, comorbidity scores and specific underlying conditions were also tabulated. We performed Kruskal Wallis and Chi-Squared analysis to test for significance between HIV- and HIV+ patients. Results The total no. of patients admitted to the YNHHS with COVID-19 infection between the period from January 6, 2020 to January 6, 2021 was 5776. A cohort 964 (16.7%) patients were screened for HIV. Much of the testing occurred in the early COVID periods (Figure 1) when PIs were considered as part of the treatment algorithm. Sixty-seven (0.07%) patients tested HIV+ with 3 (0.003%) being newly diagnosed (Fig 2). Compared to HIV- patients, HIV+ were more likely to be identified as Black, with higher mean Elixhauser Comorbidity scores and significant associations with conditions such as hypertension, pulmonary disease, complicated diabetes, liver disease, renal failure and depression (Table 1). These co-morbidities have been correlated with higher risk of hospitalization for people living with HIV (PWH). Figure 2. COVID Admission and HIV Status The graph represents HIV testing results over the entire study period. Table 1. Demographics and Comorbidites Represents demographics and comorbidities of HIV- & HIV+ patients Figure 1. COVID Admissions and HIV Testing COVID admissions over time and the performance of HIV testing Conclusion This is one of the first reports on targeted HIV testing for patients not using identifiable traditional HIV risk factors who were admitted to a large healthcare system for COVID19 infections. The percentage of newly HIV diagnosed patients from this cohort was considered to be &lt; known HIV infection rates for our population. The majority of PWH were already established in care prior to their COVID19 diagnosis. Disclosures All Authors: No reported disclosures

Alzheimer Disease and HIV: Untangling the Gordian Knot

2021 ◽  
pp. 10.1212/CPJ.0000000000001102
Author(s):  
Lambros Messinis ◽  
Grigorios Nasios
Keyword(s):  
Future Research ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Population Means ◽  
Aged People ◽  
Highly Active ◽  
Hiv Associated Neurocognitive Disorder ◽  
Living With Hiv ◽  
Long Term Survivors

Approximately one decade ago, Brew and Mystique, 1 in their compelling editorial addressed the need for conducting further studies of amyloid metabolism in aged people living with HIV. They also noted the need for future research to provide tools capable of identifying the causes of HIV – Associated Neurocognitive Disorder (HAND) within the context of successful highly active anti-retroviral therapy (HAART). Alisky in 2007, 2 had accurately predicted that successful treatment with HAART in the HIV population means more long term survivors and an aging HIV population vulnerable to develop Alzheimer’s disease (AD).

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