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Confused? Forgetful? Well, Don't Blame the Virus

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Research suggests HIV-related cognitive impairment is way overestimated. 

A recent study indicates that the way doctors assess and identify HIV-related cognitive disorders may lead to overestimating the number of people who have such disorders.

The authors of the article in Clinical Infectious Diseases said that physicians should focus on those with symptoms and should describe in detail the way HIV has contributed to a patient’s brain disease.

Those people living with HIV and who are not on antiretroviral treatment may eventually have cognitive impairment. This is known as HIV-associated dementia. Those who have it may find they have trouble with concentration, motor skills, and having depressive episodes.

In 2007, experts created criteria to better define the disorders. HIV-associated neurocognitive disorder, known as HAND for short, is based on certain cognitive tests that measure memory, language fluency, motor skills, and other areas.

In a review of over a hundred studies last year, 43 percent of people living with HIV in the studies were classified as having HAND.

However, the researchers who published the recent study say that isn’t what is seen in clinical settings, and the frequency of such disorders was low.

“Our assertion that the HAND criteria risk overestimating the extent of cognitive disorders in people with HIV should not be mistaken for a view that we do not believe HIV brain pathology and cognitive impairment in people with HIV to be important or widespread,” the researchers added, according to NAM AIDSMap. 

Instead of being based on cognitive tests, diagnoses of cognitive impairment should come from reported symptoms, and there should be clinical history showing a decline in cognitive function, the researchers said.

“A label of HAND assumes that low performance on cognitive tests in a person with HIV is caused by HIV, at least in part,” Sam Nightingale and his coauthors wrote. “In reality, some is entirely caused by HIV, some is due to a combination of HIV and comorbid factors, and in some people, HIV brain pathology may not be contributing at all.”

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Alex Cooper