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Neuropsychiatric aspects of HIV
- 6. HIV/AIDS Fact sheet N°360. http://www.who.int/mediacentre/factsheets/fs360/en/ (accessed )
- 8. (i) Direct effects of HIV on brain. 1. Delirium 2. HIV-associated neurocognitive disorder (HAND) (ii) Vulnerability of Persons with severe mental illness to HIV infection. 1. Mood disorders 2. Schizophrenia 3. PTSD 4. Personality disorders
- 9. i) Chronic course of HIV infection and the associated stigma.
- 15. Serena Spudich. HIV and Neurocognitive Dysfunction. Curr HIV/AIDS Rep 2013; 10(3) 235-243
- 16. Cellular & molecular basis of HIV associated Nueropathogenesis, Indian J Med Res; 129:Jun 2009,637-51.
- 17. Cellular & molecular basis of HIV associated Nueropathogenesis, Indian J Med Res; 129:Jun 2009,637-51.
- 21. HAND HIV-associated neurocognitive disorders ANI HIV-associated asymptomatic neurocognitive impairment Cognitive impairment involving at least two cognitive domains (performance of at least 1 SD below the mean for norms on neuropsychological tests) The cognitive impairment does not interfere with everyday functioning. MND HIV-1-associated mild neurocognitive disorder Cognitive impairment involving at least two cognitive domains (performance of at least 1 SD below the mean for norms on neuropsychological tests) The cognitive impairment produces at least mild interference in daily functioning
- 22. HAD HIV-1-associated dementia (HAD) Marked cognitive impairment involving at least two cognitive domains (performance of at least 2 SD below the mean for norms on neuropsychological tests) The cognitive impairment produces marked interference with day-to-day functioning
- 23. HOST FACTORS VIRAL FACTORS GENETICS- Apoprotein Eo4 Allele AIDS Metabolic disorder Immune Activation levels Aging –phosphorylate tau proteins HIV Subtypes Vascular disease Drug resistance Anemia CD4 Count Malnutrition Co-infection Substance abuse All of them lead to chronic inflammation
- 25. Neurocognitive Dysfn Pre HAART POST HAART HAND 35 % 44 % HAD 14 % 2 % MND 5 % 10 % ANI 10 % 32 % Justin C. McArthura and Bruce J. Brew,HIV-associated neurocognitive disorders: is there a hidden epidemic? AIDS 2010, 24:1367–1370
- 49. Diagnosis Implicated agents Depression Abacavir, Efavirenz(mc), Indinavir, Nevirapine, IFN-α, Steroids, INH. Mania Didanosine, Efavirenz, Zidovudine. Psychosis Abacavir, Efavirenz, Nevirapine, Acyclo/Ganciclovir, Prednisone. Anxiety Didanosine, Gancicylovir. Vivid dreams Abacavir, Nevirapine, Efavirenz. Suicidal ideation Abacavir, Efavirenz.
Editor's Notes
- Clinical stage 3 Unexplainedi severe weight loss (>10% of presumed or measured body weight) Unexplained chronic diarrhoea for longer than one month Unexplained persistent fever (above 37.6°C intermittent or constant, for longer than one month) Persistent oral candidiasis Oral hairy leukoplakia Pulmonary tuberculosis (current) Severe bacterial infections (such as pneumonia, empyema, pyomyositis, bone or joint infection, meningitis or bacteraemia) Acute necrotizing ulcerative stomatitis, gingivitis or periodontitis Unexplained anaemia (<8 g/dl), neutropaenia (<0.5 × 109 per litre) or chronic thrombocytopaenia (<50 × 109 per litre)
- HIV CAPSID….BULLET SHAPED CORE WHICH CONTAIN HIV RNA HIV ENVELOPE ..OUTER SURFACE OF HIV HIV GLYCOPROTEIN…PROTEIN SPIKES EMBEDDED IN HIV ENVELOPE
- HIV envelope protein binds to CD4+ cell and chemokinin co-receptor on cell surface Fusion and inserting of viral code into the cell Reverse transcription of viral genome Integration of proviral DNA into host genomic DNA Transcription of viral RNA Viral genomic RNA Budding of virus from cell and maturation.
- 2011 DATA….. Epidemic Scenario (2011) - Estimated Total Male Female Adult HIV Prevalence (%) 0.27 0.32 0.22 No. of PLHA 20,88,638 12,72,663 8,15,975 No. of CLHA 1,45,446 No. of New Infections 1,16,459 No. of AIDS related deaths 1,47,729
- Marked reduction in number of neurons following inj. of viral protein. Astrogliosis (also known as astrocytosis or referred to as reactive astrocytosis) is an abnormal increase in the number of astrocytes due to the destruction of nearby neurons from CNS trauma, infection, ischemia, stroke, autoimmune responses, and neurodegenerative disease. In healthy neural tissue, astrocytes play critical roles in energy provision, regulation of blood flow, homeostasis of extracellular fluid, homeostasis of ions and transmitters, and regulation of synapse function, and synaptic remodeling
- Subcortical dementia HIV dementia symptoms are more associated with motor slowing and loss of executive control than with language and memory disturbance. Motor symptoms are also often subtle in early stages, including occasional stumbling while walking or running, slowing of fine repetitive movements, such as playing the piano or typing, and slight tremor. On examination, patients will demonstrate impaired saccadic eye movements, dysdiadochokinesia, hyperreflexia, and, especially in later cases, frontal release signs (grasp, root, snout, and glabellar reflexes). In late stages, motor symptoms may be quite severe, with marked difficulty in smooth limb movements, especially in the lower extremities. Impairments on tests of psychomotor speed in patients at the time of AIDS diagnosis with no memory complaints have been shown to predict the development of HIV-associated dementia up to 2 years prior.
- Praxis
- HIV/HCV infection …co infection is common Effect on HAND is controversial Appears to increase severity (but not prevalence) of neurocognitive impairment on patient on treatment of HIV.
- The Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) is a working group of the Office of AIDS Research Advisory Council (OARAC). The primary goal of the Panel is to provide recommendations for HIV care practitioners based on current knowledge of antiretroviral drugs used to treat adults and adolescents with HIV infection in the United States. Recommendations in these guidelines are based upon scientific evidence and expert opinion. Each recommended statement is rated with a letter of A, B, or C that represents the strength of the recommendation and with a numeral I, II, or III that represents the quality of the evidence. Henry J. Kaiser Family Foundation. ---Kaiser is a non-profit organization focusing on national health issues, as well as the U.S. role in global health policy. Unlike grant-making foundations, Kaiser develops and runs its own policy analysis, journalism and communications programs, sometimes in partnership with major news organizations.
- For each question, patients can answer: a) never, b) hardly ever, or c) yes, definitely. Patients are considered to have an “abnormal” result when answering “yes, definitely” on at least one question.
- Efavirenz-
- A behavior contract is an agreement between a student, their parent and the teacher. It spells out the expected behavior, the unacceptable behavior, the benefits (or rewards) for improving behavior and the consequence for failing to improve behavior. This contract should be worked out with the parent and the child and is most effective if the parent reinforces the appropriate behavior, rather than the teacher. Accountability is an important part of the success of a behavior contract.
- Self-deprecation is the act of reprimanding oneself by belittling, undervaluing, or disparaging oneself,[1] or being excessively modest.[2][3] It can be used in humor and tension release. Self-deprecating and self-depreciating both mean self-belittling. Some commentators think that self-depreciating is the more apt term for this activity, but self-deprecating has far more currency in Canadian English. Either word is acceptable." To depreciate is (1) to lessen in value, or (2) to lower the value of something, especially by falsely undervaluing, disparaging, or belittling it. The word is most common in financial contexts. Deprecate traditionally means to express disapproval of, but over the last century it has gained another sense—to disparage or belittle—that makes it roughly synonymous with depreciate in that word’s second sense. The newer sense of deprecate is what’s meant in the common phrasal adjective self-deprecating, which means undervaluing oneself. Self-depreciating would carry roughly the same meaning, but it is likely to be considered a misspelling because self-deprecating is by far the more common form.