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New practical guidance for improved patient care
in HIV-associated neurocognitive disorder - Assessment, Diagnosis and Treatment of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders (HAND): A Consensus Report of the Mind Exchange Program
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Download the PDF here
Download the PDF here
press release
Friday 30 November 2012, San Diego, US - New practical guidance to help make an accurate diagnosis and aid management of cognitive dysfunction in patients with HIV is published today in Clinical Infectious Diseases1. It will complement existing HIV treatment guidelines and strongly influence the day-to-day care of people with HIV.
Developed and consolidated from the unique consensus-based, evidence-driven MIND EXCHANGE programme, the clinical importance of this consensus guidance is likely to be significant, helping clinicians to optimise detection and management of cognitive dysfunction, including HIV-associated cognitive disorder (HAND), and thereby reduce its impact on people living with HIV and their families.
"Until now, many practical clinical questions regarding the management of cognitive dysfunction in patients with HIV have remained unanswered. Greater clarity around approaches to screening, differential diagnosis, treatment and management of cognitive dysfunction, arrived at by expert consensus, will have a significant impact on how effectively we can manage this important complication of HIV" explains Dr Scott Letendre, Chairman of the MIND EXCHANGE Working Group and Professor of Medicine at the University of California, San Diego.
Although modern antiretroviral treatments continue to improve life expectancy among those affected by HIV, these patients are now living longer, and cognitive dysfunction is becoming an increasingly prevalent consideration; up to 69% of people with HIV are thought to suffer from HAND2. Even in its mild form, HAND may lead to lower medication adherence3, less ability to perform the most complex daily tasks4, worse quality of life5, difficulty obtaining employment6 and shorter survival7.
"For the first time, we have been able to put together clear guidance to help clinicians make an accurate diagnosis of cognitive dysfunction in patients with HIV, differentiating it from other common causes of neurocognitive impairment in older patients. We hope the result will be that appropriate treatment will be initiated at the earliest opportunity so that our patients can achieve the best possible outcomes" said Dr Letendre.
The MIND EXCHANGE programme was established to identify and develop, through expert consensus, practical answers to commonly raised clinical questions in the management of cognitive dysfunction. The outcome is an independent and academically-rigorous distillation of the available research data on cognitive dysfunction, combined with a consensus of opinion based on the experience of over 60 leading experts in HIV management, neurology and psychiatry, from 30 countries.
The publication summarises the key consensus recommendations of the MIND EXCHANGE programme as:
· All HIV patients should be screened for HAND as early as possible (within six months of HIV diagnosis and ideally before initiation of treatment) using a sensitive screening tool. More comprehensive neuropsychological evaluation will be needed in some cases.
· Screening should also be carried out immediately if there is evidence of clinical deterioration or at the time of major changes in clinical status (such as initiation or change in treatment).
· All individuals with neurocognitive impairment should be followed regularly, at least every 12-24 months.
· As per current treatment guidelines, combination antiretroviral therapy is recommended for routine treatment of HAND in the clinic.
References:
1. Mind Exchange Working Group. Assessment, Diagnosis and Treatment of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders (HAND): A Consensus Report of the Mind Exchange Program. Clin Infect Dis. In press 2012.
2. Simioni S, et al. AIDS 2010;24:1243Ð50.
3. Meade CS et al. J Behav. Med. 2011; 34:128-38.
4. Thames AD et al. J Clin. Exp. Neuropsychol 2011;33:200-9.
5. Parsons TD et al. Health and Quality of Life Outcomes 2006;4:11.
6. van Gorp W et al. J Int. Neuropsychol. Soc. 2007;13:80-9.
7. Tozzi V et al. AIDS Res. Hum. Retroviruses 2005;21:706-13.
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Assessment, Diagnosis and Treatment of Human Immunodeficiency Virus (HIV)-Associated Neurocognitive Disorders (HAND): A Consensus Report of the Mind Exchange Program
Kenneth H. Mayer, Section Editor
The Mind Exchange Working Group
Corresponding Author: (email: sletendre@ucsd.edu; Tel: +1 619 543 8080; Fax: +1 619 543 5066
Alternate Corresponding Author: Professor and Director, HNRC, Room 249 Stein Clinical Research Building, University of California, San Diego La Jolla, CA. 92093-0680 (Tel: +1 858 534 3652; Fax: +1 858 534 7723)
Abstract
Many practical clinical questions regarding the management of HAND remain unanswered. We sought to identify and develop practical answers to key clinical questions in HAND management. Sixty-six specialists from 30 countries provided input into the program, which was overseen by a steering committee. Fourteen questions were rated as being of greatest clinical importance. Answers were drafted by an expert group based on a comprehensive literature review. Sixty-three experts convened to determine consensus and level of evidence for the answers. Consensus was reached on all answers. For instance, good practice suggests that all HIV patients should be screened for HAND early in disease using standardized tools. Follow-up frequency depends on whether HAND is already present or whether clinical data suggest risk for developing HAND. Worsening neurocognitive impairment may trigger consideration of antiretroviral modification when other causes of have been excluded. The Mind Exchange program provides practical guidance in the diagnosis, monitoring and treatment of HAND.
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