Development of the Human-Equine Attachment Scale.

The introduction of antiretroviral therapy (ART) has substantially reduced mortality and severe morbidity associated with HIV infection. However, persistence of noninfectious comorbid conditions, including cognitive and other mental health disorders, continues to make HIV a significant public health concern. HIV has been detected in the central nervous system (CNS), as the virus can cross the blood-brain barrier during early infection stages. The presence of the virus in the brain, including within perivascular macrophages, microglia, and to a limited extent, astrocytes, is associated with persistent mild neuroinflammation. Neuroinflammation contributes to cognitive impairment (HIV-associated neurocognitive disorders [HAND]) and other mental health conditions like anxiety and depression. The most prevalent and severe form of HAND in the pre-ART era was HIV-associated dementia (HAD), which affected 10% to 20% of people with HIV (PWH). HAD is characterized by progressive neurologic and cognitive decline, severely impacting daily functioning and posing a significant threat to the health and survival of PWH.