Cognitive decline associated with human immunodeficiency virus (HIV) may be secondary to HIV-associated neurocognitive disorder (HAND) or due to true Alzheimer’s disease (AD); According to an editorial published in Neurology, new tools could help differentiate between these entities in patients with HIV.
An aging population and widespread use of highly active antiretroviral therapy (HAART) means older HIV patients are more susceptible to common non-HIV diseases that can contribute to the development of AD. Previous studies have shown an increased risk of AD in older people with HIV.
Because both HAND and AD share similar properties and risk factors, including Aβ42 plaques and deficits in episodic memory, new tools are needed to differentiate between these entities.
Several differences between HAND and AD can help differentiate between the entities. It has been suggested that extracellular vesicles / exosomes in plasma play an important role in the development of AD in patients with HIV. Anatomical patterns can distinguish HAND from mild cognitive impairments with varying degrees of tissue loss and atrophy patterns.
Calcagno and colleagues reported on the characteristics of older patients with HIV and AD and supported the use of clinical, neuropsychological, imaging, blood, and CSF biomarkers to differentiate between AD and HAND. They emphasized the importance of a multidisciplinary team approach in order to make a correct diagnosis. Although several methodological factors may limit the study, the study helped better understand the differences between HAND and AD in the HIV population.
“[T]This study is an important and timely contribution for the practicing clinician, neurologist, or otherwise, as it provides important new insights into the differentiation of HAND and AD in the HIV population, and particularly for long-term survivors of HIV who are prone to development [Alzheimer] Disease, ”concluded the study researchers.
Messinis L, Nasios G. Alzheimer’s Disease and HIV: Untangling the Gordian Knot. Neurology. Published online April 27, 2021. doi: 10.1212 / CPJ.00000000000001102
Alzheimer’s Disease and Dementia Cognitive Impairment General Infectious Disease HIV / AIDS Neurocognitive Disorders