September 2011
Understanding the neurological complications of HIV
Many people with the Human Immunodeficiency Virus (HIV), the virus that can cause AIDS, are living healthier and longer lives, thanks to advances in the understanding of HIV and antiretroviral (anti-HIV) therapies. However, while survival estimates are now excellent for treated patients with HIV, there is growing recognition that neurological impairment is a continued persistent cause of disability for people with HIV.
What the news means to you
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There is still much we need to understand about how HIV affects the brain ...
By Serena Spudich, MD
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HIV-associated neurocognitive disorder (HAND) is a common neurological disorder associated with HIV infection and AIDS. This umbrella term covers a range of disorders of increasing severity from asymptomatic — signs of impairment on neuropsychological tests but no loss of function in day-to-day life — to mild signs of impairment in both tests and daily living, to the most severe form, HIV-associated dementia.
Some HIV-infected patients experience subtle difficulties with neurological function even when receiving appropriate treatment for HIV. These problems are not usually obvious in casual conversation or even in a brief medical examination, but often are noticed by patients or their families as increased forgetfulness, difficulty with concentration on previously enjoyable tasks such as reading, lessened interest in socializing, and, in some cases, difficulty with multitasking or keeping up with complex activities at work or at home.
There is still much we need to understand about how HIV affects the brain in people with well-controlled disease. Key questions include: how common HAND is, which people are most vulnerable to HIV-related brain damage, whether and how quickly it can progress from a mild disorder to one that is more serious, and how best to treat this disorder.
The focused efforts of investigators and clinicians in our departments of neurology and medicine offer a unique resource to patients and providers with concerns regarding issues of HIV-associated neurological dysfunction. The neuro-HIV sub-specialty clinic through Yale-New Haven Hospital’s Nathan Smith Clinic is staffed by a trained neuro-infectious disease/HIV neurologist and offers opportunities for state-of-the-art evaluation of HIV patients with neurological symptoms. Patients receive multidisciplinary cutting-edge imaging and virological and immunological assessments.
For more information: The National Institute of Neurological Disorders and Stroke.
Dr. Spudich is an attending neurologist at Yale-New Haven Hospital and an associate professor of neurology at Yale School of Medicine.