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Abstract
In 1991, the AIDS Task Force of the American Academy of Neurology published nomenclature and research case definitions to guide the diagnosis of neurologic manifestations of HIV-1 infection. Now, 16 years later, the National Institute of Mental Health and the National Institute of Neurological Diseases and Stroke have charged a working group to critically review the adequacy and utility of these definitional criteria and to identify aspects that require updating. This report represents a majority view, and unanimity was not reached on all points. It reviews our collective experience with HIV-associated neurocognitive disorders (HAND), particularly since the advent of highly active antiretroviral treatment, and their definitional criteria; discusses the impact of comorbidities; and suggests inclusion of the term asymptomatic neurocognitive impairment to categorize individuals with subclinical impairment. An algorithm is proposed to assist in standardized diagnostic classification of HAND.
GLOSSARY: AAN = American Academy of Neurology; ADLs = activities of daily living; ANI = asymptomatic neurocognitive impairment; HAART = highly active antiretroviral treatment; HAD = HIV-associated dementia; HAND = HIV-associated neurocognitive disorders; HNRC = HIV Neurobehavioral Research Center; IADLs = instrumental ADLs; MCMD = minor cognitive motor disorder; MND = HIV-associated mild neurocognitive disorder; MSE = mental status examination.
Footnotes
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jm{at}jhmi.edu
Supplemental data at www.neurology.org
See also page 1781
e-Pub ahead of print on October 3, 2007, at www.neurology.org
Disclosure: The authors report no conflicts of interest.
Disclaimer: This work was written as part of Dr. Jeymohan Joseph’s and Dr. Mike Nunn’s official duties as government employees. The views expressed in this article do not necessarily represent the views of the NIMH, NINDS, NIH, DHHS, or the United States government.
Received July 12, 2006. Accepted in final form May 24, 2007.
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