HIV & the Brain – HAND

 

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When you think ‘Africa’, what’s the first disease that pops into your head? HIV? AIDS? Well, that’s accurate! In Nigeria alone, there were approximately 3.4 million people living with Human Immunodeficiency Virus (HIV) and 170 thousand deaths due to Acquired Immune Deficiency Syndrome (AIDS) in 2014 (source: UNAIDS). You can only imagine how much that number would have increased in 2016.

How does HIV affect the brain?

The primary target for HIV is the immune system – the system that protects your body against disease – but the nervous system can also be affected by the virus in different ways and extents. The virus can cause inflammation, which is detrimental to the brain and spinal cord. As a result, symptoms such as behavioural changes, confusion, forgetfulness, headaches, progressive weakness, and loss of sensation in the arms and legs can be experienced. HIV has also been shown to reduce the size of brain tissue.

Neurological conditions associated with HIV can also be caused by cancers, infections, and toxic effects of drugs used in treatment due to the compromised immune system.  Such effects as pain, seizures, lack of coordination, difficulty swallowing, anxiety disorders, depression, loss of vision, movement disorders, fever and coma have been associated with HIV treatment.

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What neurological conditions are associated with HIV?

HIV-associated neurocognitive disorder (HAND) affects more than 50% of people with HIV, as well as those on the modern combination antiretroviral treatment (CART), although to a lesser degree. HAND is the term used to describe mental problems, ranging from problems with thinking, concentration, memory, complex decision making, coordination to progressive, fatal dementia.

In 30 – 40% of patients, symptoms are so mild that they’re undetectable (asymptomatic patients). Only sensitive and extensive neurological tests might show evidence of HAND. In mild-to-moderate HAND, patients might have difficulty learning new tasks, paying attention or diminished reflexed and slower recall of memories, as well as feelings of anxiety, sadness or hopelessness.

A more severe form of HAND is seen in patients in the advanced stages of HIV, where they develop increased difficultly with memory, concentration, and a general decrease in their mental capabilities. They can also develop leg weakness and loss of coordination or balance. Brain images of these patients show that there is brain tissue shrinkage – due to loss of neurones, abnormalities is white matter, injury to structures involved in signalling and tissue inflammation. 

Another major neurological problem seen in HIV patients in peripheral neuropathy, which is a type of nerve injury in the hands and feet causing discomfort ranging from tingling and burning to severe pain. This condition can be worsened by some antiretroviral drugs.

How are neurological conditions associated with HIV diagnosed and treated?

Though HIV is diagnosed with a blood test, neurological problems associated with it cannot be diagnosed the same way. There are a number of ways neurological issues can be diagnosed, which including brain imaging techniques such as a CT or MRI scans, a biopsy where a sample of brain tissue is taken to be examined or the cerebrospinal fluid can also be examined. These tests could be time consuming and expensive, so they’re not usually recommended unless the condition is severe. Documentation of neurological issues by the patients can be very helpful when brought to the attention of their regular doctor, as they could be referred to a specialist if the symptoms are very troubling.

A highly active combination antiretroviral treatment (CART) with a cocktail of three or more drugs fighting HIV has been shown to be effective in reducing severe HAND and reversing the cognitive issues associated with HIV. Although HAND cannot be prevented, its incidence and severity can be reduced.

HAND is a condition to look out for especially in patients with advanced HIV/AIDS and in children with HIV. 

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