Assessment, diagnosis, and treatment of HIV-associated neurocognitive disorder: a consensus report of the mind exchange program

Abstract

Many practical clinical questions regarding the management of human immunodeficiency virus (HIV)-associated neurocognitive disorder (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 have been excluded. The Mind Exchange program provides practical guidance in the diagnosis, monitoring, and treatment of HAND.

Figure 1.

Overview of the Mind Exchange program. Abbreviation: KOL, key opinion leader.

Figure 2.

Algorithm showing management of treated patients with persistent or worsening neurocognitive impairment and undetectable cerebrospinal fluid human immunodeficiency virus RNA (<50 copies/mL). Abbreviations: ART, antiretroviral therapy; CPE, central nervous system penetration effectiveness; CSF, cerebrospinal fluid; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MRI, magnetic resonance imaging; NCI, neurocognitive impairment; NP, neuropsychological; RNA, ribonucleic acid; VL, viral load.