title: The burden of HIV-associated neurocognitive disorder (HAND) in the Asia-Pacific region and recommendations for screening.
abstract: BACKGROUND
  HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment.
  
  
  METHODS
  This review seeks to redress the imbalance by promoting awareness and education among physicians concerning the neurovirulence of HIV and thereby increase screening efforts to improve diagnosis rates and clinical outcomes for underserved patients in this region. The Asia, Australia, and Middle East (AAME) HAND Advisory Board convened expert regional representatives to review current practice and recommend appropriate measures related to the implementation of standardised screening programmes and treatment recommendations to curb the developing HAND epidemic in the region. In particular, we recommend basic neuropsychological testing protocols that could be efficiently introduced into clinical practice for routine screening.
  
  
  RESULTS
  We also propose simple guidelines for the management of HAND. We believe that HAND is a significant and under-reported diagnosis in HIV patients that warrants both greater recognition and further clinical investigation of the underlying pathophysiology and the impact of HIV disease progression, with HAND being associated with worse medication adherence and therefore possibly increased risk of ARV treatment failure.
  
  
  CONCLUSIONS
  Widespread screening will lead to greater recognition of HAND and earlier intervention, which may lead to improved management strategies in the future.
authors.affiliation: Department of Psychiatry, University of Melbourne, Australia. Electronic address: ieverall@unimelb.edu.au.
authors.forename: Everall
authors.initials: E
authors.lastname: Ian
authors.affiliation: Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Chan Lai
authors.initials: CL
authors.lastname: Gwen
authors.affiliation: Infectious Diseases Unit, Hospital Pulau Pinang, Penang, Malaysia.
authors.forename: Chow Ting
authors.initials: CT
authors.lastname: Soo
authors.affiliation: Department of Consultation-Liaison Psychiatry, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Corr
authors.initials: C
authors.lastname: Melissa
authors.affiliation: Department of Psychiatry, Infectious Diseases Section, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
authors.forename: Huang
authors.initials: H
authors.lastname: Chun-Kai
authors.affiliation: Department of Psychiatry, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kim
authors.initials: K
authors.lastname: Eosu
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Kim
authors.initials: K
authors.lastname: Hyo-Youl
authors.affiliation: Infectious Diseases Department, Tawam Hospital, Al Ain, United Arab Emirates.
authors.forename: Khan
authors.initials: K
authors.lastname: Asad
authors.affiliation: HIV Neurobehavioural Research Centre, Division of Infectious Disease, University of California, San Diego, USA.
authors.forename: Letendre
authors.initials: L
authors.lastname: Scott
authors.affiliation: Department of Medicine and Infectious Diseases, Queen Elizabeth Hospital, Hong Kong.
authors.forename: Li Patrick
authors.initials: LP
authors.lastname: Chung-Ki
authors.affiliation: Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thanomsak
authors.initials: T
authors.lastname: Anekthananon
authors.affiliation: Psychiatry and Behavioural Sciences and Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA.
authors.forename: Treisman Glenn
authors.initials: TG
authors.lastname: Jordan
authors.affiliation: Department of Psychiatry, Taipei Veteran's General Hospital, Taipei, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Han-Ting
authors.affiliation: Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Affiliate National Yang Ming University, College of Medicine, Taipei, Taiwan.
authors.forename: Wong
authors.initials: W
authors.lastname: Wing-Wai
mesh_terms: D001208:Asia; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D015658:HIV Infections / Q000150:complications*; D006801:Humans
keywords: Antiretroviral therapy (ART); HIV-associated neurocognitive disorders (HAND); Human immunodeficiency virus (HIV); Neuropsychological testing