Special Issue "Update on HIV-Associated Neurocognitive Disorders (HAND)"

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Clinical Neuroscience".

Deadline for manuscript submissions: closed (15 November 2019).

Special Issue Editor

Dr. Jaime H. Vera Rojas
E-Mail Website
Guest Editor
Division of Infection and Global Health, Brighton and Sussex Medical School, Brighton, UK
Interests: HIV; cognitive impairment; HIV and aging
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Effective combination antiretroviral therapy (cART) has led to a significant reduction in the prevalence and incidence of central nervous system (CNS) HIV-associated brain disease, particularly, opportunistic CNS infections and HIV encephalitis. Despite this, cognitive deficits in people living with HIV (PLWH) have become more apparent in recent years. The term HAND (HIV-associated neurocognitive impairment) has been defined as cognitive impairment associated exclusively with HIV infection. However, defining if cognitive disorders in PLWH are due to HAND or other causes can be cumbersome on an individual basis. Several clinical risk factors that contribute towards cognitive impairment in PLWH, but are not specific to HIV infection per se, have been suggested, and include ageing, greater use of recreational drugs, increase rates of depression and anxiety, and high prevalence other comorbidities (cerebrovascular disease), and co-infections (hepatitis C and syphilis) that are known to affect the CNS. The development of HAND has been associated with antiretroviral therapy (poor drug concentration vs. neurotoxicity) and low-level CNS HIV replication, but more recently the role of brain immuneactivation in the development of HAND is taking central stage and could pave the wave for the development of new anti-inflammatory therapeutics for the management of HAND. This Special Issue aims to describe current evidence for the pathogenic mechanisms associated with the development of HAND and other cognitive deficits affecting PLWH on effective cART, as well as describing novel strategies and therapeutic interventions for the management of PLWH with cognitive difficulties.

Dr. Jaime H. Vera Rojas
Guest Editor

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Keywords

  • HIV
  • HAND
  • cART

Published Papers (3 papers)

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Research

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Open AccessArticle
Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study
Brain Sci. 2019, 9(10), 278; https://doi.org/10.3390/brainsci9100278 - 17 Oct 2019
Abstract
Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in [...] Read more.
Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in cases of (1) late syphilis (acquired >2 years previously), (2) CD4+ cells ≤ 350/mm3 and/or a serum Venereal Disease Research Laboratory/Rapid Plasma Reagin (VDRL/RPR) title > 1:32, (3) “serological failure” after syphilis therapy, and (4) the use of alternative treatment for syphilis. In the present study, we aimed to verify the accuracy of the guideline’s criteria for the indication of LP in the suspicion of ANS in a cohort of PLWH. Methods: This retrospective study was carried out in a cohort of PLWH referred at a single medical center of a large academic hospital in Italy. Clinical and laboratory data of patients diagnosed with late syphilis were extracted from the cohort and analyzed. The European Guidelines of syphilis were adopted for patient management. Results: Out of a cohort of 713 PLWH, only 51 (7%) had a diagnosis of late syphilis and were therefore included in the study. Thirty-one subjects (61%) met one or more diagnostic criteria to perform LP: 39% (12/31) of patients undergoing LP had a diagnosis of ANS. The accuracy of predictive criteria for ANS, suggested by the guidelines, was 62% for RPR > 1:32 and 74% for CD4+ ≤ 350 cc/µL. The simultaneous occurrence of both criteria (RPR > 1:32 plus CD4+ ≤ 350 cc/µL) achieved a diagnostic accuracy of 59%. Interestingly, only 17% of patients who underwent LP for serological failure were eventually diagnosed positive for ANS. Conclusion: Asymptomatic neurosyphilis represents a challenging, but not uncommon, diagnosis. Therefore, it requires a careful investigation. Low CD4+ cell count and RPR > 1:32 remain excellent predictors of neurosyphilis, but have become the only acceptable predictors of ANS in PLWH. “Serologic failure” should be regarded with caution as a criterion to perform LP in order to investigate possible ANS in HIV-syphilis coinfected patients asymptomatic for neurological disorders. The retrospective nature of this single-site study may represent a limit to the interpretation of the data. Thus, larger clinical studies on the topic are warranted. Full article
(This article belongs to the Special Issue Update on HIV-Associated Neurocognitive Disorders (HAND))
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Open AccessArticle
Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV
Brain Sci. 2019, 9(2), 37; https://doi.org/10.3390/brainsci9020037 - 08 Feb 2019
Abstract
As the HIV population ages, the prevalence of cognitive impairment (CI) is increasing, yet few services exist for the assessment and management of these individuals. Here we provide an initial description of a memory assessment service for people living with HIV and present [...] Read more.
As the HIV population ages, the prevalence of cognitive impairment (CI) is increasing, yet few services exist for the assessment and management of these individuals. Here we provide an initial description of a memory assessment service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen by the clinic. We present patient demographic data, assessment outcomes, diagnoses given and interventions delivered to those seen in the clinic. 41 patients (79%) of those seen in the clinic had objective CI: 16 (31%) met criteria for HIV-associated Neurocognitive Disorder (HAND), 2 (4%) were diagnosed with dementia, 14 (27%) showed CI associated with mental illness and/or drugs/alcohol, 7 (13%) had CI which was attributed to factors other than HIV and in 2 (4%) patients the cause remains unclear. 32 (62%) patients showed some abnormality on Magnetic Resonance Imaging (MRI) brain scans. Patients attending the clinic performed significantly worse than normative scores on all tests of global cognition and executive function. Interventions offered to patients included combination antiretroviral therapy modification, signposting to other services, case management, further health investigations and in-clinic advice. Our experience suggests that the need exists for specialist HIV memory services and that such a model of working can be successfully implemented into HIV patient care. Further work is needed on referral criteria and pathways. Diagnostic processes and treatment offered needs to consider and address the multifactorial aetiology of CI in HIV and this is essential for effective assessment and management. Full article
(This article belongs to the Special Issue Update on HIV-Associated Neurocognitive Disorders (HAND))
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Review

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Open AccessReview
HIV Cerebrospinal Fluid Escape and Neurocognitive Pathology in the Era of Combined Antiretroviral Therapy: What Lies Beneath the Tip of the Iceberg in Sub-Saharan Africa?
Brain Sci. 2018, 8(10), 190; https://doi.org/10.3390/brainsci8100190 - 20 Oct 2018
Cited by 1
Abstract
Neurocognitive impairment remains an important HIV-associated comorbidity despite combination antiretroviral therapy (ART). Since the advent of ART, the spectrum of HIV-associated neurocognitive disorder (HAND) has shifted from the most severe form to milder forms. Independent replication of HIV in the central nervous system [...] Read more.
Neurocognitive impairment remains an important HIV-associated comorbidity despite combination antiretroviral therapy (ART). Since the advent of ART, the spectrum of HIV-associated neurocognitive disorder (HAND) has shifted from the most severe form to milder forms. Independent replication of HIV in the central nervous system despite ART, so-called cerebrospinal fluid (CSF) escape is now recognised in the context of individuals with a reconstituted immune system. This review describes the global prevalence and clinical spectrum of CSF escape, it role in the pathogenesis of HAND and current advances in the diagnosis and management. It highlights gaps in knowledge in sub-Saharan Africa where the HIV burden is greatest and discusses the implications for this region in the context of the global HIV treatment scale up. Full article
(This article belongs to the Special Issue Update on HIV-Associated Neurocognitive Disorders (HAND))
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