Individuals with immune systems so depleted that it can no longer fight off the virus or other threatening infections are at risk for HIV-Associated Neurocognitive Disease or HAND. HAND is a broad term used to describe a disease that produces problems related to thinking, memory and mood - sometimes physical coordination and function. HAND is often barely noticeable. In this form it is asymptomatic neurocognitive impairment (ANI). HAND can also cause mild to moderate symptoms and is then upgraded to mild neurocognitive disorder (MND). In its most rare but severe form, people may progress to HAD. All of these, from the asymptomatic to the debilitating, are covered under the term HAND.

HAND is suspected to be caused in a number of ways. The widest explanation has to do with the HIV weakening the immune cells necessary for protecting people's neurons-the cells that make up the brain and nervous system-while simultaneously revving up the immune system to the point where inflammation damages neurons over time.

If left untreated for prolonged periods of time, in its most severe form, HAD can damage the brain extensively and can be difficult to recover from. People who have contracted HAD have problems with memory and the ability to pay attention for long periods of time. It can also lead to wild mood swings and loss of physical coordination or even incontinence.

On the other hand, the milder symptoms of HAND usually go unnoticed. Only the most sensitive tests can detect them. The symptoms include:
* Difficulty recalling things that you've just read or heard
* Slower recall of facts and memories
* Trouble paying attention for long stretches
* Difficulty learning new tasks
* Feelings of sadness, hopelessness or anxiety
* Diminished reflexes
* Feeling "fuzzy headed"

These are the most common systems when experiencing the milder form of HAND. These symptoms can also be caused by other problems such as CVD, coinfection with hepatitis C virus (HCV), clinical depression and anxiety- both of which are found at high rates in people with HIV- and overuse of alcohol or recreational and prescription drugs. Medications can also cause these symptoms. ARV drugs such as efavirenz (found in Sustiva and Atripla). This makes it difficult to diagnose HAND without the proper testing.

It is important to rule out other diseases before considering HAND. If HAND is suspected, a diagnosis should be sought from a neurological specialist who is knowledgeable in the HIV/AIDS field. This specialist needs to be aware of the necessary tests to make such a diagnosis.

If you feel you are experiencing these symptoms and suspect HAND, document these problems and consult your doctor who will be able to assist you in assessing whether you need to be referred to a specialist.