Substance use disorders, substance intoxication, and substance withdrawal are highly co- morbid with other mental disorders. Comorbid posttraumatic stress disorder, psychotic disorders, depressive and bipolar disorders, and neurodevelopmental disorders can con- tribute to neurocognitive impairment in substance users. Traumatic brain injury occurs more frequently with substance use, complicating efforts to determine the etiology of NCD in such cases. Severe, long-term alcohol use disorder can be associated with major organ system disease, including cerebrovascular disease and cirrhosis. Amphetamine-induced
NCD may be accompanied by major or mild vascular NCD, also secondary to amphet- amine use.
Due to HIV Infection
A. The criteria are met for major or mild neurocognitive disorder.
B. There is documented infection with human immunodeficiency virus (HIV).
C. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.
D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.
Coding note: For major neurocognitive disorder due to HIV infection, with behavioral dis- turbance, code first 042 (320) HIV infection, followed by 294.11 (F02.81) major neurocog- nitive disorder due to HIV infection, with behavioral disturbance. For major neurocognitive disorder due to HIV infection, without behavioral disturbance, code first 042 (320) HIV in- fection, followed by 294.10 (F02.80) major neurocognitive disorder due to HIV infection, without behavioral disturbance.
For mild neurocognitive disorder due to HIV infection, code 331.83 (631.84). (Note: Do not use the additional code for HIV infection. Behavioral disturbance cannot be coded but should still be indicated in writing.)
HIV disease is caused by infection with human immunodeficiency Virus type-l (HIV—l), which is acquired through exposure to bodily ﬂuids of an infected person through injection drug use, unprotected sexual contact, or accidental or iatrogenic exposure (e.g., contami- nated blood supply, needle puncture injury to medical personnel). HIV infects several types of cells, most particularly immune cells. Over time, the infection can cause severe depletion of ”T-helper” (CD4) lymphocytes, resulting in severe immunocompromise, often leading to opportunistic infections and neoplasms. This advanced form of HIV infection is termed acquired immune deficiency syndrome (AIDS). Diagnosis of HIV is confirmed by established laboratory methods such as enzyme-linked immunosorbent assay for HIV antibody with
Western blot confirmation and/ or polymerase chain reaction—based assays for HIV.
Some individuals with HIV infection develop an NCD, which generally shows a ”sub- cortical pattern” with prominently impaired executive function, slowing of processing speed, problems with more demanding attentional tasks, and difficulty in learning new information, but fewer problems with recall of learned information. In major NCD, slow- ing may be prominent. Language difficulties, such as aphasia, are uncommon, although reductions in ﬂuency may be observed. HIV pathogenic processes can affect any part of the brain; therefore, other patterns are possible.
Major or Mild Neurocognitive Disorder Due to HIV Infection 633