Cognitive dysfunction in HIV patients despite long-standing suppression of viremia.
OBJECTIVE
To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs.


METHODS
Assessment of HANDs with neuropsychological tests.


METHODS
Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed.


RESULTS
Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2-136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers.


CONCLUSIONS
The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs.
Simioni
Samanta
S
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Cavassini
Matthias
M
Annoni
Jean-Marie
JM
Rimbault Abraham
Aline
A
Bourquin
Isabelle
I
Schiffer
Véronique
V
Calmy
Alexandra
A
Chave
Jean-Philippe
JP
Giacobini
Ezio
E
Hirschel
Bernard
B
Du Pasquier
Renaud A
RA
D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D014766:Viremia / Q000517:prevention & control*
D012367:RNA, Viral