scholarly journals HIV-ASSOCIATED NEUROCOGNITIVE DISORDER (HAND) PADA PASIEN DENGAN HIV TANPA INFEKSI OPORTUNISTIK

2019 ◽  
Vol 2 (3) ◽  
pp. 11-12
Author(s):  
Dhyatmika Gde Putra ◽  
Widyastuti Ketut ◽  
Laksmidewi AAA. Putri
Keyword(s):  
Learning Ability ◽  
Fixed Dose ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Clock Drawing Test ◽  
Immunodeficiency Virus ◽  
New Learning ◽  
Dose Combination ◽  
Hiv Associated Neurocognitive Disorder ◽  
Trial Making Test

Latar Belakang: Infeksi Human Immunodeficiency Virus (HIV) telah menjadi epidemi di seluruh dunia termasuk di Indonesia. Salah satu komplikasi infeksi HIV pada sistem saraf pusat (SSP) berupa gangguan fungsi kognitif yang disebut HIV-associated neurocognitive disorder (HAND). Replikasi HIV dalam jangka waktu panjang terjadi pada astrosit dan mikroglia, yang dapat menurunkan fungsi neuronal. HAND terkait dengan aktivitas virus dan mediator inflamasi sel imun pada SSP sehingga menyebabkan kerusakan neuron otak. Kasus: Pasien perempuan, 28 tahun, suku Bali, mengeluh mudah lupa yang dialami sejak 2 tahun lalu. Pasien masih dapat melakukan aktivitas sehari-hari secara mandiri walaupun keluhan lupa terkadang dirasakan mengganggu. Pasien memiliki riwayat infeksi HIV sejak bulan September 2015 dengan CD4 16 sel/µl dan mendapat terapi ARV fixed-dose combination dengan regimen tenofovir, lamivudine, dan efavirenz. Pemeriksaan neurobehavior dijumpai atensi baik, gangguan memori terutama new learning ability, memori tunda, asosiasi berpasangan, gangguan visuospasial dan eksekutif, ADL dan IADL mandiri, MMSE: 24, MoCA Ina: 14, Clock Drawing Test: 3, Trial making test A baik, Trial making test B terganggu, International HIV Dementia Scale (IHDS): 10.5, Skala penilaian depresi Hamilton: 15. Hasil CT Scan kepala dalam batas normal. Diskusi: Dari hasil pemeriksaan, pasien dikategorikan dalam HAND tipe Asymptomatic Neurocognitive Impairment (ANI). Kadar CD4 diketahui berhubungan dengan derajat kerusakan neuron otak dan kadar CD4 nadir rendah (≤ 200 sel/µl) merupakan faktor risiko terjadinya gangguan kognitif pada pasien dengan HIV. Pemberian terapi kombinasi ARV dapat menunjukkan peningkatkan performa fungsi kognitif dan fungsional. Simpulan: Infeksi HIV secara langsung pada SSP dapat menyebabkan gangguan neurokognitif dan inisiasi pemberian terapi ARV dini merupakan usaha pencegahan terjadinya perburukan lebih lanjut.

Global prevalence and burden of HIV-associated neurocognitive disorder

Neurology ◽  
2020 ◽  
Vol 95 (19) ◽  
pp. e2610-e2621 ◽  
Author(s):  
Yunhe Wang ◽  
Moxuan Liu ◽  
Qingdong Lu ◽  
Michael Farrell ◽  
Julia M. Lappin ◽  
...  
Keyword(s):  
Data Extraction ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
Cd4 Cell Count ◽  
Hiv Associated Neurocognitive Disorder ◽  
Sub Saharan ◽  
High Level

ObjectiveTo characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.MethodsWe searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.ResultsOf 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).ConclusionsOur findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

scholarly journals HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Jade C. Mogambery ◽  
Halima Dawood ◽  
Douglas Wilson ◽  
Anand Moodley
Keyword(s):  
Prospective Study ◽  
Functional Impairment ◽  
Eastern Cooperative Oncology Group ◽  
Surrogate Marker ◽  
Depression Scale ◽  
Diagnostic Tools ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Kwazulu Natal ◽  
Hiv Associated Neurocognitive Disorder

Introduction: HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings.Objectives: This prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal. Factors associated with HAND were examined, alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score and an association between HAND and non-adherence to antiretroviral therapy (ART) was explored.Methods: Between May 2014 and May 2015, 146 ART-naïve outpatients were assessed for HAND. IHDS score ≤ 10 established a diagnosis of HAND. Functional capacity was assessed using Eastern Cooperative Oncology Group (ECOG) score. Chi-squared test was used to identify risk factors for HAND. The get-up-and-go test (GUGT) and Center for Epidemiological Studies Depression scale – revised (CESD-r) were tested against the IHDS. HIV viral load done six months after initiating ART was used as a surrogate marker for adherence to ART.Results: The prevalence of HAND was 53%. In total, 99.9% of patients with HAND had no functional impairment. Age > 50 years old was associated with HAND (p = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence (p = 0.06).Conclusions: While the prevalence of HAND is high, it is not associated with functional impairment which suggests that asymptomatic neurocognitive impairment is prevalent. Age > 50 years old is a risk factor for HAND. The GUGT and CESD-r are not useful diagnostic tools for HAND. The relationship between HAND and non-adherence should be further explored.

scholarly journals Lack of Antiviral Activity of Darunavir against SARS-CoV-2

2020 ◽  
Author(s):  
Sandra De Meyer ◽  
Denisa Bojkova ◽  
Jindrich Cinatl ◽  
Ellen Van Damme ◽  
Christophe Buyck ◽  
...  
Keyword(s):  
Antiviral Activity ◽  
Positive Control ◽  
Hiv Protease ◽  
Fixed Dose ◽  
Hiv Protease Inhibitors ◽  
Cyp3a4 Inhibitor ◽  
Immunodeficiency Virus ◽  
Dose Combination ◽  
Therapeutic Alternatives

AbstractGiven the high need and the absence of specific antivirals for treatment of COVID-19 (the disease caused by severe acute respiratory syndrome-associated coronavirus-2 [SARS-CoV-2]), human immunodeficiency virus (HIV) protease inhibitors are being considered as therapeutic alternatives. Prezcobix/Rezolsta is a fixed-dose combination of 800 mg of the HIV protease inhibitor darunavir (DRV) and 150 mg cobicistat, a CYP3A4 inhibitor, which is indicated in combination with other antiretroviral agents for the treatment of HIV infection. There are currently no definitive data on the safety and efficacy of DRV/cobicistat for treatment of COVID-19. The in vitro antiviral activity of darunavir against a clinical isolate from a patient infected with SARS-CoV-2 was assessed. DRV showed no activity against SARS-CoV-2 at clinically relevant concentrations (EC50 >100 μM). Remdesivir, used as a positive control, showed potent antiviral activity (EC50 = 0.38 μM). Overall, the data do not support the use of DRV for treatment of COVID-19.

Natural Bioactives as a potential Therapeutic Modality against NeuroAIDS

2021 ◽  
Vol 21 ◽  
Author(s):  
Musheer Ahmed ◽  
Ashif Iqubal ◽  
Sanjula Baboota ◽  
Javed Ali
Keyword(s):  
Antiretroviral Therapy ◽  
Ex Vivo ◽  
Therapeutic Modality ◽  
Neuroprotective Activity ◽  
Neurocognitive Disorder ◽  
Combination Antiretroviral Therapy ◽  
Bioactive Constituents ◽  
Asymptomatic Neurocognitive Impairment ◽  
Therapy Regimen ◽  
Hiv Associated Neurocognitive Disorder

: With the introduction of antiretroviral therapy, the worldwide AIDS-related deaths have decreased, and life expectancy has increased, so has the prevalence of AIDS-related neurological disorders or neuroAIDS. HIV associated neurocognitive disorder such as mild neurocognitive disorder and asymptomatic neurocognitive impairment have largely remained stable or increased among the HIV infected individuals in the combination antiretroviral therapy era and with the emerging evidence that antiretrovirals with high CNS penetration effectiveness score contribute to the neurotoxicity and HIV associated neurocognitive disorder. have ushered the search for natural, nontoxic bioactive constituents having pre-established neuroprotective, anti-inflammatory and restorative neurocognitive activity. In this review, we have highlighted the probable mechanism of neuroAIDS infection, the problem with the existing antiretroviral therapy, along with various bioactive constituents with in vivo, in vitro, or ex vivo evidence of their neuroprotective activity that can be used as an adjuvant with the current combination antiretroviral therapy regimen or can even serve as an alternate to the antiretrovirals for treatment of HIV associated neurocognitive disorder.

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