HIV

HIV-associated neurocognitive impairments

Revised research criteria for HIV-associated neurocognitive disorders (HAND) (Antinori et al, 2007)

1) HIV-associated asymptomatic neurocognitive impairment (ANI)

a. Acquired impairment in cognitive functioning, involving at least two domains, documented by performance of at least 1.0 SD below the mean for age-education appropriate norms

b. Cognitive impairment does not interfere with everyday functioning

c. Cognitive impairment does not meet criteria for delirium or dementia

d. There is no evidence of another preexisting cause for the ANI

2) HIV-associated mild neurocognitive disorder (MND)

a. Acquired impairment in cognitive functioning, involving at least two domains, documented by performance of at least 1.0 SD below the mean for age-education appropriate norms

b. The cognitive impairment produces at least mild interference in daily functioning, at least one of the following:

i. Self-report of reduced mental acuity, inefficiency in work, homemaking, or social functioning

ii. Observation by knowledgeable others that the individual has undergone at least mild decline in mental acuity with resultant inefficiency in work, homemaking, or social functioning

c. The cognitive impairment does not meet criteria for delirium or dementia

d. There is no evidence of another preexisting cause for the MND

i. If there is a prior diagnosis of MND, but currently the individual does not meet criteria, the diagnosis of MND in remission can be made

ii. If the individual with suspected MND also satisfies criteria for a severe episode of major depression with significant functional limitations or psychotic features, or substance dependence, the diagnosis of MND should be deferred to subsequent examination conducted at a time when the depression has remitted or at least 1 month after cessation of substance use

3) HIV-1-associated dementia (HAD)

a. Marked acquired impairment in cognitive functioning involving at least two domains; typically, the impairment is in multiple domains, especially in learning of new information, slowed information processing, and defective attention/concentration, documented by performance of at least 2.0 SD below the mean for age-education appropriate norms

b. The cognitive impairment produces marked interference with day-to-day functioning (work, home life, social activities)

c. The pattern of cognitive impairment does not meet criteria for delirium, or if delirium is present, criteria for dementia need to have been met on prior examination without delirium present

d. There is no evidence of another, preexisting cause for the dementia (CNS infection, CNS neoplasm, CVD, preexisting neurologic disease, or severe substance abuse)

i. If there is a prior diagnosis of HAD, but currently the individual does not meet criteria, the diagnosis of HAD in remission can be made

ii. If the individual with suspected HAD also satisfies criteria for a severe episode of major depression with significant functional limitations or psychotic features, or substance dependence, the diagnosis of HAD should be deferred to subsequent examination conducted at a time when the depression has remitted or at least 1 month after cessation of substance use

References

Antinori, A. et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69, 1789–1799 (2007). PubMed link