Hiv-Associated Neurocognitive Disorders (Report)

South Africa continues to be home to the world's largest population of people living with HIV. (1) In developed countries such as the USA, the introduction of highly active antiretroviral therapy (HAART) as the mainstay of HIV treatment has resulted in impressive reductions in the incidence of severe HIV-associated neurocognitive disorders (HAND) and impacted favourably on survival rates in patients with HIV infection. (2) Neurocognitive impairments, however, do not present universally among all HIV-infected persons. Neuropsychological signs and symptoms of at least mild extent have been found in approximately 30% of persons with asymptomatic HIV infection and about 50% of individuals with AIDS. (3) Furthermore, despite the apparent reduction in the incidence of HIV-associated dementia (HAD), the incidences of milder forms of HAND appear relatively stable and may even have increased in individuals who are not immunosuppressed. (4) Therefore, despite the remarkable improvements in the USA, HAND will probably remain a public health concern of increasing severity in South Africa, given that the majority of adults and children in the region in need of antiretroviral therapy do not have access to it. This article reviews the current diagnostic nosology for HAND and the neuropsychological domains typically affected by the HIV disease. The review concludes with a discussion of the commonly used neuropsychological screening tools for the detection and diagnosis of HAND.