Very large deficits would be required to produce changes in MMSE and TICS, and performance on these measures cannot exclude the presence of more subtle cognitive impairments.
However, more subtle neurologic impairment is likely to be more frequent with systematic magnetic resonance imaging studies demonstrating new cerebral perfusion defects in 72 91% of patients [ 27, 28].
Fifth, we restricted analyses to participants with an MMSE score > 24 to minimize the opportunity for bias from participants with evidence of more subtle cognitive impairment.
Over half of children who have had a silent infarct will require special services in school or be retained a grade level, indicating poor academic achievement and more subtle cognitive impairment [ 11].
Despite this much more subtle degree of impairment, HAND in the current era may affect daily function, antiretroviral adherence, and quality of life [ 4– 6].
However, the latter may provide a more comprehensive assessment and is perhaps more likely to identify subtle impairments, such as mood, pain, behaviour and fatigue as they emerge over time, with familiarity.
More subtle functional and physical impairments may also be evident.
Adult patients experience more subtle symptoms such as impairments in executive function (time management, organization, and goal-oriented activity), difficulties in relationships, poor motor vehicle driving skills, and psychiatric comorbidities including substance abuse disorders [ 12, 17, 18].
7 Although severe cognitive disorders rarely occur in patients effectively treated with combination antiretroviral therapy (cART, plasma HIV RNA <50 copies/mL), more subtle forms of cognitive impairment are present in about 50% of long-term survivors with treated HIV infection.
We cannot exclude that the effect of hypothalamic impairment is more subtle and therefore not detectable with the current design.
