title: Screening for cognitive impairment in human immunodeficiency virus.
abstract: Recent publications estimate the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) exceeds 50%, and this rate is likely higher among older patients. Cognitive impairment may impact medication adherence, and symptomatic impairment has been linked to all-cause mortality providing some impetus for early detection. There are currently insufficient data to inform solid recommendations on screening methods. Most HIV-specific tools have poor performance characteristics for all but the most severe form of impairment, which accounts for <5% of cases. Reliance on symptoms is likely to miss a substantial proportion of individuals with HAND due to poor insight, confounding mood disturbances, and lack of well-informed proxies. In the aging HIV-positive population, broader screening tools may be required to allow sensitivity for both HIV and neurodegenerative disorders. We describe the clinical presentation of HAND, review existing data related to screening tools, and provide preliminary and practical recommendations in the absence of more definitive studies.
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California–San Francisco, USA. vvalcour@memory.ucsf.edu
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
authors.forename: Robert
authors.initials: R
authors.lastname: Paul
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chiao
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Wendelken
authors.forename: Bruce
authors.initials: B
authors.lastname: Miller
mesh_terms: D000375:Aging; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D009483:Neuropsychological Tests; D015995:Prevalence; D012680:Sensitivity and Specificity