Patient education: HIV-associated neurocognitive disorders (The Basics)

What are HIV-associated neurocognitive disorders? — This is the term doctors use for thinking and memory problems that can happen in some people with HIV infection. It is sometimes called "HAND" for short.

HIV is the virus that causes AIDS. It attacks the body's infection-fighting system, called the "immune system." It can cause many different problems, including problems thinking normally. HAND can be mild or more severe:

●Milder forms of HAND – Some people do not show any obvious symptoms in their normal life. Or they might have mild symptoms that affect their ability to think, focus, or do certain tasks.

●HIV-associated dementia – This is the term doctors use for the most severe form of HAND. Dementia is a brain disorder that causes thinking and memory problems, plus problems with movement or emotions. These problems make it hard to work or do other daily activities.

HIV-associated dementia is not as common as it used to be. That's because in many parts of the world, people with HIV start taking medicines soon after finding out they have the infection. These medicines, called "antiretroviral therapy," help control HIV infection and lower the risk of other health problems related to HIV.

What are the symptoms of HAND? — Symptoms of HAND can start very mild. Some people do not show any obvious symptoms in their normal life. Their symptoms are only noticed if a doctor asks them to answer certain questions or do specific tasks.

In some people symptoms stay mild over time and even improve. But in other people, symptoms get worse slowly.

Milder symptoms can include:

●Trouble reading or focusing

●Having a hard time doing complex tasks or solving problems

●Minor memory problems, like forgetting appointments or losing track of things

●Thinking or understanding things more slowly than before

More severe symptoms, such as with HIV-associated dementia, can include:

●Major memory problems, like not recognizing loved ones or forgetting events from the past

●Moving and reacting more slowly than usual

●Trouble walking steadily or smoothly

●Personality changes – A person who has HIV-associated dementia might stop expressing emotions the way they used to. They might act irritable or seem like they don't care about anything. They might also lose interest in sex or other things they used to enjoy.

Should I see a doctor or nurse? — Yes. See a doctor or nurse if you think you or someone close to you might have HAND. The symptoms are sometimes caused by other medical conditions that can be treated. Doctors can also give advice or medicines to help with symptoms.

Is there a test for HAND? — No, there is no one test. The doctor or nurse can do an exam, ask questions, and decide which tests are best for the person's individual situation. The goal is to find out if the person's symptoms are related to HIV or another problem.

If a person with HIV has symptoms of dementia, doctors might do a CT scan or MRI of the brain. These are imaging tests that create pictures of the inside of the brain. They can help doctors tell if symptoms are caused by HIV or a different condition. Another possible test is called a lumbar puncture (also called a "spinal tap"). In this procedure, a doctor puts a thin needle into a person's lower back and takes out a small amount of spinal fluid. Lab tests of the fluid can tell the doctor more about what might be causing dementia symptoms.

How is HAND treated? — The main treatment is to start the person on HIV treatment, if they are not taking it already. This involves taking "antiretroviral" medicines to control the infection. This can help slow the progression of thinking and memory problems related to HIV.

If a person has symptoms of HIV-associated dementia, the doctor might prescribe other medicines, too. They will also do regular exams, talk to the person about their condition, and do regular tests to see if symptoms change over time.

The doctor will also suggest treatments for any related health problems. For example, if the person has symptoms of depression, medicines can help with this. Doctors will check the person often to make sure treatment is working.

Experts are studying whether activity and exercise might help improve symptoms of HAND. In general, getting regular physical activity is good for a person's health.

More on this topic

Patient education: Dementia (including Alzheimer disease) (The Basics)
Patient education: Evaluating memory and thinking problems (The Basics)
Patient education: HIV/AIDS (The Basics)
Patient education: Mild cognitive impairment (The Basics)

Patient education: Dementia (including Alzheimer disease) (Beyond the Basics)