2021/04/23 by Sam Nightingale, Anna J. Dreyer, Anna J Dreyer +5
Immunology and Microbiology · Medicine · #HIV Research and Treatment #HIV-related health complications and treatments #HIV/AIDS Research and Interventions
paper · doi:10.1093/cid/ciab366
openalex publication_date 2021/04/23 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) criteria are frequently used to describe cognitive impairment in persons living with HIV (PLWH) across diverse populations globally. These criteria typically find 20-60% of PLWH meet criteria for HAND, which does not tally with clinical observations in the modern era that cognitive disorders present relatively infrequently. Most with HAND have asymptomatic neurocognitive impairment; however, the significance of low cognitive test performance without symptoms is uncertain. Methods underlying HAND criteria carry a false-positive rate that can exceed 20%. Comorbidities, education, and complex socioeconomic factors can influence cognitive test performance, further increasing the potential for misclassification. We propose a new framework to characterize cognitive impairment in PLWH that requires a clinical history and acknowledges the multifactorial nature of low cognitive test performance. This framework is intended to be applicable across diverse populations globally, be more aligned with clinical observations, and more closely represent HIV brain pathology.