A screening algorithm for HIV-associated neurocognitive disorders.
BACKGROUND
HIV physicians have limited time for cognitive screening. Here we developed an extra-brief, clinically based tool for predicting HIV-associated neurocognitive impairment (HAND) in order to determine which HIV-positive individuals require a more comprehensive neurological/neuropsychological (NP) assessment.


METHODS
Ninety-seven HIV-positive individuals with advanced disease recruited in an HIV out-patient clinic received standard NP testing. A screening algorithm was developed using support vector machines, an optimized prediction procedure for classifying individuals into two groups (here NP-impaired and NP-normal) based on a set of predictors.


RESULTS
The final algorithm utilized age, current CD4 cell count, past central nervous system HIV-related diseases and current treatment duration and required approximately 3 min to complete, with a good overall prediction accuracy of 78% (against the gold standard; NP-impairment status derived from standard NP testing) and a good specificity of 70%.


CONCLUSIONS
This noncognitive-based algorithm should prove useful to identify HIV-infected patients with advanced disease at high risk of HAND who require more formal assessment. We propose staged guidelines, using the algorithm, for improved HAND therapeutic management. Future larger, international studies are planned to test the predictive effect of nadir CD4 cell count, hepatitis C virus infection, gender, ethnicity and HIV viral clade. We recommend the use of this first version for HIV-infected Caucasian men with advanced disease.
Cysique
L A
LA
Brain Sciences, University of New South Wales, Sydney, Australia.
Murray
J M
JM
Dunbar
M
M
Jeyakumar
V
V
Brew
B J
BJ
D000328:Adult; D000367:Age Factors; D000465:Algorithms; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003661:Decision Support Techniques; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019562:Viral Load
D044966:Anti-Retroviral Agents