Unfortunately, the medical establishment and advocacy groups have only described the cognitive impairment as ME/CFS, which is symptomatic, ignoring the work of Kenneth Podell and Dr. Apple at UCSF.
The day after it was known that SARS-Cov-2 depletes the CD4 compartment, Kenneth Podell published his paper in which he stated individuals would be living with the functional equivalent of HIV Associated Neurocognitive Decline. ncbi.nlm.nih.gov
One can draw on the experience with an HIV/AIDS epidemic. The initial understanding of HIV/AIDS was that of the virus affecting the immune system by depleting T cells, which resulted in opportunistic infections of multiple organs, including the brain.
However, it did not take long to discover that the disease could also attack the brain directly, which resulted in long-term cognitive impairment.
Subsequently, HIV encephalopathy and AIDS dementia complex leading to long-term cognitive impairment were discovered [87]. Based on the emerging literature, it is reasonable to hypothesize a somewhat similar scenario may unfold in relationship to COVID-19.
In her study, Dr. Apple relied upon the test for HIV Associated Neurocognitive Decline. ucsf.edu
For those living with HIV who are not described as Neurocognitively Normal, their impairment is graded relying the Frascati criteria, the very criteria Dr. Apple used. ncbi.nlm.nih.gov
Seventy percent of her control arm met the diagnostic criteria for Asymptomatic Neurocognitive Impairment, demonstrating impairment in at least two cognitive domains (performance of at least 1 standard deviation below the mean for norms).
Deprived of individuals who read in the middle of a pandemic, those diagnosed with ANI face a two to six times increased risk of further disease progression.
Next, the functional equivalent of Mild Neurocognitive Decline, defined as demonstrating impairment in at least two cognitive domains (performance of at least 1 standard deviation below the mean for norms) and some impairment in daily functioning.
Finally, the functional equivalent of AIDS Dementia Complex, demonstrating impairment in at least two cognitive domains (performance of at least 2 standard deviations below the mean for norms) and marked interference with daily functioning.
Among the biomarkers used to diagnose ADC is Neurofilament Light Chain, detected in the CSF of these individuals. frontiersin.org
Would be great to see trials involving drug repurposing and Voxel Based Morphometry performed as HIV positive individuals experience no more loss in brain volume with antiviral initiation.
After the initiation of cART, there was no further brain volume loss or cortical thinning.
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