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
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.
18.
19.
20.
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
24.
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
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.