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