Intranasal Treatment of HIV-associated Neurocognitive Disorders

Inclusion Criteria:

• Documented HIV-1 infection
• Maintained on stable ART for ≥6 months (defined as undetectable viral load)
• HAND-MND or -ANI diagnosis with evidence of clinical onset or progression within the prior 2 years, based on established criteria
• Currently followed at the Southern Alberta Clinic (SAC; Calgary, AB, Canada)

Exclusion Criteria:

• HAND with a) changed dose of any medication for HIV-1 infection with a corresponding increase in viral load (e.g., ART), or b) secondary therapies for HAND (e.g., memantine, amphetamines).
• Advanced liver, renal or lung disease, cancer or diabetes requiring insulin
• Secondary diagnosis of neurocognitive impairment or other major neuropsychiatric illness such as epilepsy, Alzheimer's or Parkinson's diseases, major depression (PHQ-9 score >10), or schizophrenia
• Central nervous system lesion (diagnosed by neuroimaging) that may impair cognition
• Previous allergic reaction to insulin or any of the carrier components.
• Education < 9 years or inability to read and write English fluently
• Uncontrolled HIV-1 or hepatitis C co-infection
• Inability to perform NP or questionnaire measures, functional illiteracy
• Past or current substance abuse that could interfere with the study assessments as determined by the PI
• Marijuana use on the day of NP testing
• Uncontrolled cardiovascular disease (hypertension, coronary or peripheral artery disease)