Phil Nottingham
RMN, M.Sc.
ADHB HIV &
Mental Health
Liaison Nurse
HIV ASSOCIATED NEUROCOGNITIVE DISORDERS
HAND
What is HAND
How is affects people
The Past
The Present
What we can do about it
An Interesting Paper
THE PRESENTATION:
TERMINOLOGY
HIV-1 infection and cognitive impairment
Schouten et al. AIDS 2011, 25:561–575
Cognitive:
“The set of all mental abilities and
processes related to knowledge, attention,
memory and working memory, judgment and
evaluation, reasoning and attention”
Very important for most of what we do
TERMINOLOGY
Cognitive complaints are common in HIV
Acute delirium secondary to a legion of metabolic
and infectious complications
HIV-associated neurocognitive disorders – directly
related to the presence of the virus in the CNS
(HAND)
Other chronic cognitive impairments not directly
related to HIV (alcohol &/or other drugs, Hep C,
vascular)
Cognitive symptoms associated psychiatric illness
HIV & COGNITIVE IMPAIRMENT
Before HAART
Cognitive impairment associated with HIV
recognised from early in epidemic
- Usually with advanced disease
- Often a prelude to death
- Both “AIDS Dementia Complex” and
milder forms of cognitive impairment
were described
HIV RELATED RISK FACTORS FOR
NEUROCOGNITIVE DISORDERS
Designated HIV wards - Full
Beds frequently blocked – nowhere to go
Many lonely and isolated people
Emaciated young people with blank empty
staring faces
Sitting in geriatric chairs staring at food not
knowing how to get food from the plate to
their mouths
IMAGES AND MEMORIES OF LATE
80S
MAIN FEARS REGARDING HIV- 1992
Living with uncertainty
Disfigurement & pain in the course of illness
The loss of friends, lovers & family
Social stigma from disclosure of
relationships, sexual orientation or HIV risk
associated behaviour
Neurological Impairment & the loss of the
ability to make decisions for oneself
MAIN FEARS REGARDING HIV - 1992
Life sustaining measures, such as
mechanical ventilation & resuscitation
Death & dying
Making decisions about having children
Unemployment & financial loss
Loss of a sense of future
Lack of control & increasing dependence
on others
Bor. R., Miller. R & Goldman. E. (1992)
After HAART – people living longer
- Cognitive symptoms are seen but often milder
- Factors - Length of HIV infection, older age at
time of seroconversion, degree of
immunodeficiency, lowest CD4 count
- Need to optimise antiretroviral treatment,
address & treat co-morbidities particularly
substance use & depression
- Ageing people with co-morbidities
HIV RELATED RISK FACTORS FOR
NEUROCOGNITIVE DISORDERS