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HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis

Author
Richard W Price, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Changes in memory, concentration, attention, and motor skills are common in HIV-infected patients and present a diagnostic challenge to the clinician [1]. Since these symptoms can be caused by a variety of disorders, accurate diagnosis is critical for patient treatment [2]. When not clearly attributable to an alternate cause other than HIV infection, such impairments have been collectively classified as HIV-associated neurocognitive disorders (HAND).

The epidemiology, clinical manifestations, and diagnosis of HIV-associated neurocognitive disorders will be discussed here. Management of HIV-associated neurocognitive disorders are discussed elsewhere. (See "HIV-associated neurocognitive disorders: Management".)

An overview of the range of neuropsychiatric conditions associated with HIV infection and more detailed reviews of other specific conditions are discussed separately. (See "Overview of the neuropsychiatric aspects of HIV infection and AIDS" and "Depression, mania, and schizophrenia in HIV-infected patients" and "Substance abuse and addiction in HIV-infected patients".)

TERMINOLOGY

The presence of neurocognitive deficits in certain HIV-infected individuals without alternative explanation other than HIV infection has long been recognized. However, the terminology to refer to this phenomenon has undergone substantial evolution since its initial characterization. In order to assist in diagnosis and categorization for research and clinical purposes, a working group supported by the United States National Institutes of Health published a classification scheme in 2007 that was initially proposed by the HIV Neurobehavioral Research Center at the University of California, San Diego [3]. This classification, often referred to as the "Frascati criteria," has been widely, but not universally, adopted [4]. It includes three levels of impaired neuropsychological test performance and functional impairment within an umbrella term, HIV-associated neurocognitive disorders (HAND):

Asymptomatic neurocognitive impairment (ANI) – defined by a score of one standard deviation or more below the mean in at least two cognitive domains on standardized neuropsychological testing without a symptomatic or observable functional impairment.

                                

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