NR326 Mental Health Nursing

Introduction

It is evident that acquired immunodeficiency syndrome is a type of chronic and potentially life-threatening condition which is found to cause by human immunodeficiency virus (Giroir, 2020). This virus is found to damage the immune system which reduces the ability of the immune system to fight against infection and progresses the development of other disease (Thakur et al., 2019). Similarly, it is also found that HIV is associated with neurological complication as it is found to damage the nerves throughout the body resulting in weakness known as neuropathy. Thus, it has been reported that HIV triggers the development of HIV-associated neurocognitive disorder (HAND) which progresses the deterioration of behaviour, cognition, memory and motor function. This condition occurs during the last stage of HIV-infection (Bhatti et al., 2016). The below paper will discuss about HAND and will recommend diagnosis and treatment based upon an article.

Discussion

Eggers et al., (2017) performed a study for determining HIV-1 associated neurocognitive disorder and provided a brief idea about pathogenesis, epidemiology, treatment and diagnosis. The study stated that development of antiretroviral treatment for human immunodeficiency virus (HIV-1) was found to lower the incidence many opportunistic infections. However, this treatment failed to lower the incidence of severe dementia among HIV patient and thereby enhanced the incidence of HIV-associated neurocognitive disorder and this issue was highly prevalent in clinical practice.

Relevance Of The Topic

The topic is highly relevance because mental health practitioners often face challenges in addressing the issue in detecting the disease. It is found that older adults is found to be suffering from neurological disorders which results in more detrimental effect (Rubtsova et al., 2017). The mental health professionals are responsible are providing emotional, social, economical and psychological needs which requires knowledge about the specific disease and various treatment procedure available. The mental health nurse must provide education and involve family in the care process which will help in detecting the disease deterioration (Erlandson & Karris, 2019). However, it is evident that the HIV patient develops this condition at the end stage of HIV and requires effective treatment.

Statistics

It has been found that the prevalence of asymptomatic neurocognitive impairment, HIV-associated dementia, and neurocognitive illness is 23.5%, 5% and 13.3% as per Frascati criteria (Wei et al., 2020). Wang et al., (2020) completed a study for understanding the global prevalence and burden of HIV-associated neurocognitive illness. The researcher performed a systematic review and included cohort or cross-sectional studies. The study result determined that the overall prevalence of HAND was 42.6% with confidence interval of 39.7-45.5 and the data did not fluctuate with diagnostic standards. The study determined that the occurrence of HAND was highly related with the level of CD4 base. The study overall suggested that there is a roughly 16,145,400 cases were detected as HAND among HIV-infected adults and the maximum cases were reported in Sub-Saharan African and Latin America. The study clearly indicated that the prevalence of HAND is even high in the antiretroviral therapy period. However, the study stated that early adherence to antiretroviral therapy, enhanced CD-4 count and prevention of severe immunosuppression will be effective in reducing the severity of the condition.

Summarisation Of The Article

Eggers et al., (2017) performed a study for determining HIV-1 associated neurocognitive disorder and provided a brief idea about pathogenesis, epidemiology, treatment and diagnosis. The researcher stated that in the modern era of antiretroviral management of human immunodeficiency virus infection the occurrence of devious infection has been reduced but the development of neurological disorder is still in high prevalence which result in challenges in clinical practice. The study also highlighted about predominant clinical manifestation such as attention, concentration, subcortical dementia and loss of memory. HAND development also results in lack of proper motor function which results un gait disturbance and impairment in manual dexterity. It is also found that development of HAND also hampers the brain function.

The study provided a brief discussion about the various stages of HIV-associated asymptomatic neurocognitive damage.  HIV-1-associated symptomless neurocognitive impairment (ANI) is characterised by damage in the cognitive functioning which involves at least two areas of ability which is documented by performance. In this stage the cognitive function does not interfere with the everyday function, mental acuity or social functioning. HIV-1-associated mild neurocognitive disorder (MND) this condition is characterised by interference in daily work activities and the last stage HIV-1-associated dementia (HAD) is characterised by damage in cognitive function along with that it is found to hamper day to day functioning. The study also provided a brief discussion about the history and prevalence. It has been found that the prevalence of neurocognitive dysfunction is found to increase recently by 20 to 50% and the condition can be treated by involving the patient in early antiretroviral therapy (Eggers et al., 2017).

The study discussed about various diagnostic procedure which can be used for detecting HAND among HIV-infected person are neurocognitive testing, cerebrospinal fluid, radiology testing and electrophysiological studies. It has been found that Quantitative neurocognitive testing is the furthermost appropriate means and the gold standard to determine neurocognitive testing. The testing includes working memory, speech, attention, executive function, information processing. Similarly, MRI testing is found to deliver hyperintense signals in the basal ganglia and white matter. Cerebrospinal fluid is primarily used for determining the opportunistic infection by determining the concentration of albumin and protein. The study also provided a brief pathophysiology about the disease development occurs due to the HIV-virus entry to the brain parenchyma by monocytes and lymphocytes. The score of scientific neurologic disfunction is connected to the extent of macrophage initiation on histopathology. The drugs such as Tenofovir, Didaosine, Abacavir and Zidovudine will be useful in reducing the condition (Eggers et al., 2017).

Use Of Information

The information will be helpful performing a diagnosis of the patient suffering from HIV and had symptoms of HAND. The study provided a list of differential diagnosis which can be used for detecting other symptom. The use of treatment and diagnostic testing will be effective in performing clinical practice (Saylor et al., 2016).  The article helped in understanding the disease progression and thereby will be effective in recommending treatment.

Strength And Weakness

The article provided a detailed discussion about the diagnostic procedure. It also provided a clear idea of disease progression. The differential diagnosis information will be effective in distinguishing various condition associated condition. The study was limited in providing a statistical data or evidence-based data about the suggested medication.

Recommendation

The study can be recommended for providing a detail enhanced data about HAND progression and its associated condition. The knowledge will be beneficial for nurses in monitoring vital signs or determining the patient’s need. Ancillary diagnostics will be effective in determining the condition which can be used in clinical practice (Winston & Spudich, 2020)

Conclusion

The above paper discussed about HIV-associated neurocognitive disease along with its statistics, diagnosis and treatment. It is also found that HIV is associated with neurological complication as it is found to damage the nerves throughout the body resulting in weakness known as neuropathy. It has been reported that HIV triggers the development of HIV-associated neurocognitive disorder (HAND) which progresses the deterioration of behaviour, cognition, memory and motor function. The disease development occurs due to the HIV-virus entry to the brain parenchyma by monocytes and lymphocytes. The score of scientific neurologic disfunction is connected to the extent of macrophage initiation on histopathology. The paper also discussed about the strength and limitation of the article.

References

Bhatti, A. B., Usman, M., & Kandi, V. (2016). Current Scenario of HIV/AIDS, Treatment Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus, 8(3), e515. https://doi.org/10.7759/cureus.515

Eggers, C., Arendt, G., Hahn, K., Husstedt, I. W., Maschke, M., Neuen-Jacob, E., ... & Straube, E. (2017). HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. Journal of neurology, 264(8), 1715-1727. DOI 10.1007/s00415-017-8503-2

Erlandson, K. M., & Karris, M. Y. (2019). HIV and Aging: Reconsidering the Approach to Management of Comorbidities. Infectious disease clinics of North America, 33(3), 769–786. https://doi.org/10.1016/j.idc.2019.04.005

Giroir B. P. (2020). The Time Is Now to End the HIV Epidemic. American journal of public health, 110(1), 22–24. https://doi.org/10.2105/AJPH.2019.305380

Rubtsova, A. A., Kempf, M. C., Taylor, T. N., Konkle-Parker, D., Wingood, G. M., & Holstad, M. M. (2017). Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors. Current HIV/AIDS reports, 14(1), 17–30. https://doi.org/10.1007/s11904-017-0347-y

Saylor, D., Dickens, A. M., Sacktor, N., Haughey, N., Slusher, B., Pletnikov, M., Mankowski, J. L., Brown, A., Volsky, D. J., & McArthur, J. C. (2016). HIV-associated neurocognitive disorder--pathogenesis and prospects for treatment. Nature reviews. Neurology, 12(4), 234–248. https://doi.org/10.1038/nrneurol.2016.27

Thakur, K. T., Boubour, A., Saylor, D., Das, M., Bearden, D. R., & Birbeck, G. L. (2019). Global HIV neurology: a comprehensive review. AIDS (London, England), 33(2), 163–184. https://doi.org/10.1097/QAD.0000000000001796

Wang, Y., Liu, M., Lu, Q., Farrell, M., Lappin, J. M., Shi, J., ... & Bao, Y. (2020). Global prevalence and burden of HIV-associated neurocognitive disorder: a meta-analysis. Neurology, 95(19), e2610-e2621. https://doi.org/10.1212/WNL.0000000000010752

Wei, J., Hou, J., Su, B., Jiang, T., Guo, C., Wang, W., Zhang, Y., Chang, B., Wu, H., & Zhang, T. (2020). The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis. Frontiers in neurology, 11, 581346. https://doi.org/10.3389/fneur.2020.581346

Winston, A., & Spudich, S. (2020). Cognitive disorders in people living with HIV. The Lancet HIV, 7(7), e504-e513. DOI: https://doi.org/10.1016/S2352-3018(20)30107-7

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