HIV Dementia
ChatGPT HIV-associated neurocognitive disorders (HAND), including HIV-associated dementia (HAD), involve cognitive impairments in memory, attention, and motor skills. HAD is diagnosed when cognitive deficits in two domains and daily life difficulties are evident. Screening for mild deficits is debatable. Antiretroviral therapy (ART) is the primary treatment, often leading to improvement within weeks to months. In cases with neuropsychiatric features or dementia, adjunctive medications like methylphenidate may be considered, with safety assessments and referrals as needed.
Overview and Diagnosis of HAND
HAND encompasses cognitive impairments in HIV patients, including HIV-associated dementia (HAD). HAD is characterized by subcortical dysfunction, attention-concentration impairment, depressive symptoms, and impaired psychomotor precision. It often occurs in advanced, untreated HIV infection with CD4 cell counts <200 cells/microL. Diagnosis involves scoring two standard deviations below the mean in at least two cognitive domains with concurrent impairment in daily living activities.
Screening for HAND
The value of screening for neurocognitive impairment in HIV-infected patients is debated. While it might identify mild deficits affecting medication adherence, the benefit of choosing ART regimens based on central nervous system penetration is unproven. Screening involves symptom inquiries and brief neurocognitive tests, including questions about memory loss, attention difficulties, and slower reasoning.
Treatment Approaches for HAND
- Antiretroviral Therapy (ART): The primary treatment for HAND, particularly effective in treating and preventing HAD. Recommended regimens include tenofovir-emtricitabine plus dolutegravir or abacavir-lamivudine plus dolutegravir.
- Monitoring Response: Clinical evaluation of neurocognitive and functional status is essential. Improvement is usually observed within weeks and continues over months, although the extent and rate of recovery vary.
- Adjunctive Treatments: In cases with prominent neuropsychiatric features, adjunctive psychotropic medications like methylphenidate may be required.
Management of Neuropsychiatric Features
For patients exhibiting prominent neuropsychiatric symptoms or dementia, additional psychotropic medications may be necessary. Safety assessments and appropriate referrals for supervision are also critical.
References
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