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From the Clinical Department (A.A.), National Institute for Infectious Diseases "Lazzaro Spallanzani," Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Neurology (G.A.), Heinrich Heine University, Dusseldorf, Germany; Departments of Neurology and Psychiatry (J.T.B.), University of Pittsburgh, PA; Department of Neurology and HIV Medicine (B.J.B.), St. Vincents Hospital, University of New South Wales, Sydney, Australia; Department of Psychiatry and Pathology (D.A.B.), The Mount Sinai Medical Center, New York, NY; Department of Psychiatry (M.C., I.G., R.K.H., K.R.R.), University of California, San Diego; Department of Neurology (D.B.C.), Washington University, St. Louis, MO; Clinic of Infectious Diseases (P.C.), San Raffaele Hospital, Milan, Italy; Department of Neurology (L.G.E.), Children’s Memorial Hospital, Chicago, IL; Departments of Psychiatry, Neurology and Psychology (K.G.), University of Miami, FL; Department of Infectious Diseases (M.G.), Sahlgrenska University Hospital, Göteborg, Sweden; Center for Mental Health Research on AIDS (J.J.), National Institute of Mental Health, Bethesda, MD; Department of Neurology (K.M.), Columbia University, New York, NY; Department of Medicine, Allergy and Infectious Diseases (C.M.M.), Department of Neurology, University of Washington Seattle; Departments of Neurology, Pathology, and Epidemiology (J.C.M.), and Department of Neurology (N.S.), Johns Hopkins University, Baltimore, MD; National Institute of Neurological Disorders and Stroke (M.N.), NIH, Bethesda, MD; Departments of Neurology (R.W.P.) and Laboratory Medicine and Medicine (L.P.), University of California, San Francisco; Department of Neurology (K.R.R.), University of North Carolina School of Medicine; Hawaii AIDS Clinical Research Program (V.V.), University of Hawaii, Honolulu; and NeuroAIDS Program and Department of Neurology (V.E.W.), University of Puerto Rico, Medical Sciences Campus.
Address correspondence and reprint requests to Dr. Justin C. McArthur, Johns Hopkins Hospital, Meyer Building, Room 6-109, 600 North Wolfe Street, Baltimore, MD 21287-7609
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.
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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