Working Group Releases Guidelines for Improved Care of HIV-associated Cognitive Impairment

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All people with HIV should be screened for HIV-associated neurocognitive disorders soon after testing positive, and those with evidence of impairment should be monitored regularly, according to international consensus guidelines developed by the Mind Exchange Working Group published in the November 28, 2012, advance edition of Clinical Infectious Diseases. Beyond antiretroviral therapy (ART), however, there are limited options for managing neurocognitive problems.

Although severe HIV-related dementia has become uncommon in the era of effective antiretroviral treatment, upwards of half of HIV positive people may experience some degree of neurocognitive impairment -- in many cases only detectable using specialized tests. HIV-associated neurocognitive disorders, or "HAND," are a growing concern as people with HIV age, and they may have practical consequences such as reduced adherence to treatment.

The Mind Exchange Working Group brought together more than 60 experts from 30 countries to develop practical answers to key clinical questions about managing HIV-associated neurocognitive disorders.Based on an international survey of HIV clinicians, the working group formulated 14 questions of greatest clinical importance. An expert group then conducted a literature search for relevant data using PubMed and the Cochrane Library, which guided development of consensus recommendations.

The working group looked at issues in 5 areas: screening, diagnosis, monitoring, treatment or interventions, and prevention. The group was able to reach consensus on all answers.

Recommendations

"The clinical importance of HAND is receiving increasing attention as patients are surviving longer and neurocognitive health has become an issue of importance in the HIV and general community," the Mind Exchange Working Group wrote.

"Both HIV and non-HIV forms of neurocognitive impairment are diagnosed much earlier than they were in the past," they continued. "Despite this, some have questioned the benefit of early diagnoses when there is no proven treatment. But in the context of HIV infection, which is likely to be a chronic disease lasting decades in most patients, we have highlighted that there are already better treatment practices and that early diagnosis is a crucial step in identifying patients at risk, as well as patients in need of more frequent monitoring or specific interventions, including medication adherence checks."

"Until now, many practical clinical questions regarding the management of cognitive dysfunction in patients with HIV have remained unanswered," working group chair Scott Letendre from theUniversity of California at San Diego said in a press release. "For the first time, we have been able to put together clear guidance to help clinicians make an accurate diagnosis of cognitive dysfunction in patients with HIV, differentiating it from other common causes of neurocognitive impairment in older patients. We hope the result will be that appropriate treatment will be initiated at the earliest opportunity so that our patients can achieve the best possible outcomes."

12/18/12

Reference

Mind Exchange Working Group. Assessment, Diagnosis and Treatment of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders (HAND): A Consensus Report of the Mind Exchange Program. Clinical Infectious Diseases. November 28, 2012 (Epub ahead of print).

Other Source

New Practical Guidance for Improved Patient Care in HIV-Associated Neurocognitive Disorder. Press release. November 30, 2012.