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HIV
Published in Meera Chand, John Holton, Case Studies in Infection Control, 2018
The common complications arising from immunodeficiency in the latter stages of the disease are listed in Table 8.2. Malignancies associated with HIV infection are listed in Table 8.3. It should be noted that, although many organisms will predominantly affect one organ system, many infections may be disseminated in the severely immunosuppressed. In addition, there are multiple possible complications arising from the effects of the virus itself. These include HIV-associated nephropathy (HIVAN) (a form of focal sclerosing glomerulosclerosis) and HIV-associated neurocognitive disorder (HAND). The final group of complications are multifactorial in origin and include an increased risk of cardiovascular disease, decreased bone mineral density, and dyslipidemia.
Introducing brain injury in the global context
Published in Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster, Addressing Brain Injury in Under-Resourced Settings, 2017
Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster
With regard to other brain-related conditions, HIV-associated neurocognitive disorder (HAND) is a major problem in sub-Saharan Africa. Yusuf et al. (2014) reported that 21.5 per cent of the 418 HIV-positive patients in their study had HAND. Furthermore, the average age of the patients in this particular study was only 37.2 years. This statistic gives some indication of the longer-term economic, social and community disruption HAND may potentially cause and the burden it places on the region. Habib et al. (2013) highlighted the substantial burden HAND places on sub-Saharan Africa, and provided data showing the beneficial effect of antiretroviral therapy.
Dementia Associated with Medical Conditions
Published in Marc E. Agronin, Alzheimer's Disease and Other Dementias, 2014
Infection with HIV is associated with direct viral damage to the CNS, which, in turn, leads to increasing degrees of neuropsychiatric impairment. HIV-associated neurocognitive disorder (HAND) is the term used to encompass three subtypes: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia or HAD (Giunta et al., 2013); the latter term is also known as HIV encephalopathy or AIDS dementia complex. HAD is characterized by the development of impaired attention or concentration, memory impairment, mental or motor slowing, incoordination, poor balance, and tremors. Language dysfunction is less common, and overall the clinical picture resembles a subcortical dementia (American Psychiatric Association, 2013). Common psychiatric symptoms include sleep disturbances, sexual dysfunction, apathy, agitation, and psychosis.
An up-to-date evaluation of dolutegravir/abacavir/lamivudine for the treatment of HIV
Published in Expert Opinion on Pharmacotherapy, 2022
Brandon L Christensen, Darrell HS Tan
DTG may be associated with higher rates of neuropsychiatric side effects including headache, insomnia, and dizziness [42]. However, the literature on its relationship with HIV-associated neurocognitive disorder (HAND) remains mixed. Rates of discontinuation due to neuropsychiatric side effects in the SINGLE, FLAMINGO, and SPRING-II trials were not different than comparator regimens. In one case series, increased suicidal ideation was noted after starting DTG but an association has not been established [48]. There is evidence showing higher rates of DTG discontinuation in women over men (HR = 2.64 95%CI = 1.23–5.65), with note that additional study is needed given the predominance of men in the original trials [49]. Evidence for this is furthered by an analysis showing women had higher rates of INSTI discontinuation for any adverse event compared to men [50]. One study exploring the neuropsychiatric effects of switching from DTG/ABC/3TC to EVG/COBI/FTC/TAF showed improvement in patient reported symptoms, neuropsychiatric adverse events, and neurocognitive status [41]. Moreover, there is some evidence that longer duration of INSTI exposure, particularly DTG, is associated with poor neurocognitive performance [51]; however, literature remains limited.
Efavirenz use and neurocognitive performance among older people living with HIV who were on antiretroviral therapy
Published in AIDS Care, 2020
Pei Qin, Jianmei He, Zixin Wang, Xi Chen, Jinghua Li, Ada Wai Tung Fung, Hui Jiang, Jie Chen, Anna Wong, Joseph Tak Fai Lau
Cognitive impairment and related diseases are prevalent among older PLWH and require intensive health care and caretaking (Blaylock & Wortmann, 2015). It is more problematic among PLWH than their counterparts, as they often face stigma (Emlet, 2006), family rejection (Webel et al., 2014) and obstacles against service utilization (Churcher, 2013). HIV-associated neurocognitive disorder (HAND) is prevalent and consequential (Heaton et al., 2010; Sevigny et al., 2007). The CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study (n = 1,555) reported that nearly half of the PLWH suffered from HAND (Heaton et al., 2010). Three studies conducted in western countries have reported prevalence of HAND of 37%–69.9% among older PLWH (Becker, Lopez, Dew, & Aizenstein, 2004; Fernandes Filho & de Melo, 2012; Valcour et al., 2004).
Objective memory as an indicator of functional impairment in native Spanish-speaking patients with HIV infection
Published in AIDS Care, 2019
Amalia García Torres, Alejandro González-Andrade, Juan José Fernández Muñoz, Miguel Pérez García, Esperanza Vergara-Moragues
HIV-Associated Neurocognitive Disorder (HAND) can include severe motor symptoms and cognitive deficits (García-Torres, Vergara-Moragues, Piñón-Blanco & Pérez-García, 2015; Vázquez-Justo, Vergara-Moragues, Piñón-Blanco, Guillén-Gestoso & Pérez-García, 2016). Memory – an extremely sensitive indicator of HAND and a strong predictor of HIV patients’ daily functioning problems – is one of the most affected cognitive areas (Avci et al., 2018; Vance, Ross, & Downs, 2008). HAND prevalence ranges between 20% to 69% and the most severe form of the disorder is HIV-Associated Dementia (HAD), characterized by a performance of at least two standard deviations below the mean on neuropsychological tests (Carroll & Brew, 2017; Nightingale & Winston, 2017). Nevertheless, minor disorders like HIV-associated mild neurocognitive disorder (MND) and asymptomatic neurocognitive impairment (ANI), characterized by a performance of at least one standard deviation below the mean on neuropsychological tests, also present with cognitive impairment and in the MND there are interferences with daily activities (Antinori et al., 2007).