Assessment and Management of HIV-Associated Cognitive Impairment: Experience from a Multidisciplinary Memory Service for People Living with HIV

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 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.

<p>Prevalence and Predictors of Neurocognitive Impairment in Ethiopian Population Living with HIV</p>

“…Gender, education, marital status, current CD4 count and hospital stay were included in the model based on previous studies showing them to be consistent predictors for neurocognitive impairment. [25][26][27][28][29][30][31][32] The logistic regression model was statistically significant, χ2 (9) = 72.91. The model explained 35.0% (Nagelkerke R 2 ) of the variance in neurocognitive impairment status and correctly classified 75.8% of cases.…”

Multiple Neuroinvasive Pathways in COVID-19

“…The mechanism of this brain pathology can be a result of opportunistic infections of the brain or primary HIV encephalopathy, where HIV affects the brain directly [87]. The degree of cognitive impairment may range from very mild to full-blown AIDS dementia complex (ADC) [99]. ADC is usually seen at advanced symptomatic stages and is associated with low CD4+ T cell count.…”

“…Neuroimaging studies of HIV patients have found that the frontal lobes, striatum, and hippocampi are particularly impacted [100]. Cognitive impairment in HIV encephalopathy is associated with a range of symptoms, including mood and personality changes, executive deficit, memory impairment, and motor/psychomotor slowing [99].…”

Prevalence and predictors of HIV-associated Neurocognitive Disorder in Ethiopians

“…Gender, education, marital status, current CD4 count and hospital stay were included in the model based on previous studies showing them to be consistent predictors for HAND (18)(19)(20)(21)(22)(23)(24)(25). The logistic regression model was statistically signi cant, χ2(9) = 72.91.…”