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From the Clinical Department (A.A.), National Institute for Infectious Diseases "Lazzaro Spallanzani," Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy; Department of Neurology (G.A.), Heinrich Heine University, Dusseldorf, Germany; Departments of Neurology and Psychiatry (J.T.B.), University of Pittsburgh, PA; Department of Neurology and HIV Medicine (B.J.B.), St. Vincents Hospital, University of New South Wales, Sydney, Australia; Department of Psychiatry and Pathology (D.A.B.), The Mount Sinai Medical Center, New York, NY; Department of Psychiatry (M.C., I.G., R.K.H., K.R.R.), University of California, San Diego; Department of Neurology (D.B.C.), Washington University, St. Louis, MO; Clinic of Infectious Diseases (P.C.), San Raffaele Hospital, Milan, Italy; Department of Neurology (L.G.E.), Children’s Memorial Hospital, Chicago, IL; Departments of Psychiatry, Neurology and Psychology (K.G.), University of Miami, FL; Department of Infectious Diseases (M.G.), Sahlgrenska University Hospital, Göteborg, Sweden; Center for Mental Health Research on AIDS (J.J.), National Institute of Mental Health, Bethesda, MD; Department of Neurology (K.M.), Columbia University, New York, NY; Department of Medicine, Allergy and Infectious Diseases (C.M.M.), Department of Neurology, University of Washington Seattle; Departments of Neurology, Pathology, and Epidemiology (J.C.M.), and Department of Neurology (N.S.), Johns Hopkins University, Baltimore, MD; National Institute of Neurological Disorders and Stroke (M.N.), NIH, Bethesda, MD; Departments of Neurology (R.W.P.) and Laboratory Medicine and Medicine (L.P.), University of California, San Francisco; Department of Neurology (K.R.R.), University of North Carolina School of Medicine; Hawaii AIDS Clinical Research Program (V.V.), University of Hawaii, Honolulu; and NeuroAIDS Program and Department of Neurology (V.E.W.), University of Puerto Rico, Medical Sciences Campus.
* To whom correspondence should be addressed. E-mail: jm{at}jhmi.edu.
ABSTRACT
In 1991, the AIDS Task Force of the American Academy of Neurology published nomenclature and research case definitions to guide the diagnosis of neurologic manifestations of HIV-1 infection. Now, 16 years later, the National Institute of Mental Health and the National Institute of Neurological Diseases and Stroke have charged a working group to critically review the adequacy and utility of these definitional criteria and to identify aspects that require updating. This report represents a majority view, and unanimity was not reached on all points. It reviews our collective experience with HIV-associated neurocognitive disorders (HAND), particularly since the advent of highly active antiretroviral treatment, and their definitional criteria; discusses the impact of comorbidities; and suggests inclusion of the term asymptomatic neurocognitive impairment to categorize individuals with subclinical impairment. An algorithm is proposed to assist in standardized diagnostic classification of HAND.
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