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Neuropsychological profile of milder forms of HIV-associated neurocognitive decline after the antiretroviral era

      Introduction: Neuropsychological profile of HIV-Associated Neurocognitive Disorder (HAND) was described before and at the beginning of the highly active antiretroviral therapy (HAART) era by psychomotor slowing, decreased attention, impairment in executive functions and memory (learning and recall) with relatively preserved language, and visuoconstructive abilities, all consistent with a “subcortical” pattern of cognitive impairment. Since the prevalence of severe forms of HAND has decreased because of HAART, the incidence of mild forms of HAND (asymptomatic neurocognitive impairment, ANI and mild neurocognitive disorder, MND) continues to increase. New studies that describe the neuropsychological profile of milder forms of HAND are needed to characterize patients in early stages of cognitive impairment.
      Methods: 46 HIV patients without history of head injury trauma or opportunistic infections of the CNS were recruited from the HIV clinic, underwent a thorough clinical interview and neuropsychological testing using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The subtests included attention and speeded information processing, episodic memory, working memory, executive function and visuoperception. Verbal fluency was examined using FAS.
      Results: Prevalence of HAND diagnoses were 26.2% for ANI, 33.3% for MND, and 40.5% were diagnosed as cognitive healthy. HAND patients showed impairment in executive functions, episodic memory and verbal fluency, but no significant changes in psychomotor slowing.
      Discussion: The neuropsychological profile of HAND changed after the HAART era: Mild forms of HAND are characterized principally by executive dysfunction and episodic memory impairment, but not overall psychomotor slowing. This is relevant for early diagnosis and the development of new HAND screening tools.