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Major or Mild Neurocognitive Disorder due to HIV Infection

Prevalence

Approximately one-third to over one-half of HIV- infected individuals have at least mild neurocognitive disturbance, but some of these disturbances may not meet the full criteria for mild NCD.
An estimated 25% of individuals with HIV will have signs and symptoms that meet criteria for mild NCD, and in fewer than 5% would criteria for major NCD be met.

Paradoxically, NCD due to HIV infection has not declined significantly with the advent of combined antiretroviral therapy, although the most severe presentations (consistent with the diagnosis of major NCD) have decreased sharply.
Contributory factors may include:
1. Inadequate control of HIV in the central nervous system (CNS).
2. The evolution of drug-resistant viral strains.
3. The effects of chronic long-term systemic and brain inflammation.
4. The effects of comorbid factors such as aging, drug abuse, past history of CNS trauma, co-infections, such as with the hepatitis C virus.

The criteria are met for major or mild neurocognitive disorder.
There is documented infection with human immunodeficiency virus (HIV).
The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

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