Abstract：
Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies.
摘要：
目前对HIV感染者认知障碍进行分类的方法可能会高估疾病负担，并导致疾病机制的模糊性。2007年HIV相关神经认知障碍（HAND）标准，有时被称为弗拉斯卡蒂标准，可以错误地将超过20％的认知健康个体归类为认知障碍。HAND的最低标准仅根据认知测试的表现来满足，这可能不适合具有不同教育和社会经济背景的人群。认知障碍的不精确表型可以限制机制研究，生物标志物发现和治疗试验。重要的是,高估认知障碍有可能在艾滋病毒感染者中造成恐惧，并加剧对这些人的污名和歧视。为了解决这个问题，我们成立了国际艾滋病毒认知工作组，它具有全球代表性，涉及艾滋病毒感染者社区。我们就针对HIV感染者认知障碍的诊断和分类新方法的六项建议达成共识，旨在集中讨论和辩论。我们建议从概念上分离与HIV相关的脑损伤-包括活性或预处理遗留损伤-与HIV感染者中发生的其他脑损伤原因。我们建议从定量神经心理学方法转向强调临床背景。我们的建议旨在更好地反映全球不同环境中HIV感染者认知障碍的变化，并为临床管理和研究研究提供更清晰的分类框架。
