Lucette Cysique, of the University of New South Wales, spoke to us at the HIV Endgame conference and answered questions about HIV-Associated Neurocognitive Disorder (HAND).
Descriptive Transcript
The HIV Endgame logo appears on screen. Text reads: Lucette Cysique answers questions on HIV and the brain. Lucette Cysique sits in front of a wood-paneled wall and answers questions from off-camera interviewers. The text of each question appears between clips.
Lucette Cysique: My name is Lucette Cysique, and I’m a researcher at the University of New South Wales, in Australia. And I’m based in a research institute which is called Neuroscience Research Australia. And, in that institute, I lead research into neuro-HIV.
Q: What do we still not know about HIV and the brain?
Cysique: So, basically, when people are on antiretroviral treatment, the theory is that the HIV replication is controlled. So the HIV virus itself, which was the main effector of cognitive problems in people without treatment is actually suppressed. And so, despite this, we still see some cognitive dysfuntions, brain changes, and we don’t understand why. So, I think that’s really the key question at the moment. We are not certain of what is causing the problem.
And, the other side of the coin is that when people are on treatment, they live much longer, which is a very good thing. But, with living longer comes several types of morbidities that are mostly related to aging, including cardiovascular disease. And the risk of maybe developing neurodegenerative disease maybe quicker than the general population. So, I think that’s the other aspect of research that’s really a hot topic at the moment. Trying to understand if, to a certain extent, what is causing the cognitive changes in people with HIV on treatment. If it’s not only HIV itself, or some residual effect of HIV. Or if it’s something related to multiple comorbidities related to aging.
Q: What should family doctors keep an eye out for?
Cysique: When people are on treatment again, the deficit that they experience is relatively mild. So, they’re not demented. But they’re going to come to the clinic with some complaint. They’re usually going to complain, “Oh I have difficulty with my memory. I have difficulty concentrating. I have difficulty paying attention to things. I used to do this easily, now it’s coming harder. At work, you know, I have difficulty to perform as well as I used to.” And, the other complaint as well is a lot about finding words. Quite a few patients complain about finding words.
And, what we find? We find that, because the deficits are really mild, for most people, actually, what it means is they have a fairly good insight into their problems. So, I think what I would advise to clinicians is, actually listen to that kind of complaint and not sort of put it aside and think oh, you know, maybe it’s depression, maybe… No, actually, the research shows that there’s a good correlation between objective cognitive testing and the subjective memory complaints that some patients have. So, there are still a certain number of patients who can experience cognitive deficits are still are less aware of it. But, overall, I would take this as — as one way for detecting any difficulties. And the other way, if there’s any doubt for the clinician, is to send people for more advanced clinical investigation, including formal neuropsychological testing.
Q: Do we have standard wasy to measure HAND?
Cysique: So, I guess, going back a little bit in history, there’s been a group, in the past relatively early in the history of the epidemic, who came together and designed a set of tests that had to be used, you know, to detect HIV dementia. But, it was a fairly long battery. It was several hours.
And then, this was eventually morphed into something different, that gave the rise to what has been called the Frascati Criteria. Which is basically a nomenclature to diagnose HAND. And in that — in those criteria, it is recommended to assess certain cognitive functions. But the tests themselves are not specified.
So that, what has happened is that people have been using relatively different tests, you know, around the world. There’s the issue, as well, that some of the tests may not be cross-culturally valid. So, what people can do in Canada may be different from what they can do say, in China, or anywhere else, right? But there are some groups that have really pushed for standardization. So, for example, myself, I use a battery that’s very similar to where I was trained, back in San Diego. And there’s been quite a few people in the world who have used that battery of tests. Then, you know, people in different — investigators in different countries just decide to do what they want, and it creates — there’s a problem of standardization, to a certain extent.
I mean, it could be worse. I know some fields where it’s worse. But I think it can get better. So, I think one of the things we want to do with Sean Rourke tonight is talk about that. Trying to push for like, a very strong level of harmonization in testing. Because, if people are using different methods, then it’s really hard to understand what’s going on.
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Note on content: Interview questions have been edited for brevity.