title: Routine detection and management of neurocognitive impairment in HIV-positive patients in a UK centre.
abstract: We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2-4.7%) had documented HAD. Eleven patients (7.3%; CI 3.7-12.7%) reported recent symptoms suggesting NCI; most of these individuals were diagnosed with a psychiatric or substance-use disorder. Among specialist referrals with symptoms suggesting NCI, 11 were diagnosed with HAD from a clinic population of 3129 individuals (annual incidence 0.4%; CI 0.2-0.6%). No patients with mildly symptomatic or asymptomatic HAND were identified in either sample, suggesting that such patients remain undetected in current clinical practice. Evidence-based screening for HAND in HIV clinics may be needed.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London.
authors.forename: L J
authors.initials: LJ
authors.lastname: Haddow
authors.forename: A
authors.initials: A
authors.lastname: Accoroni
authors.forename: J D
authors.initials: JD
authors.lastname: Cartledge
authors.forename: H
authors.initials: H
authors.lastname: Manji
authors.forename: P
authors.initials: P
authors.lastname: Benn
authors.forename: R J C
authors.initials: RJ
authors.lastname: Gilson
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003072:Cognition Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS dementia complex; HIV infection; HIV-associated dementia; HIV-associated neurocognitive disorder; asymptomatic neurocognitive impairment; cross-sectional studies; prevalence
references.citation: HIV Ther. 2010 May;4(3):371-379
references.pmid: 20824119
references.citation: Neurology. 2010 Sep 28;75(13):1150-8
references.pmid: 20739646
references.citation: Neurology. 2007 Oct 30;69(18):1789-99
references.pmid: 17914061
references.citation: AIDS. 2010 Jun 1;24(9):1243-50
references.pmid: 19996937
references.citation: Ann Neurol. 2008 Feb;63(2):213-21
references.pmid: 17894380
references.citation: AIDS. 2010 Mar 13;24(5):723-7
references.pmid: 20057312
references.citation: AIDS Behav. 2011 Nov;15(8):1888-94
references.pmid: 21437726
references.citation: J Infect Dis. 1988 Nov;158(5):1079-83
references.pmid: 3053922
references.citation: Neurology. 1991 Jun;41(6):778-85
references.pmid: 2046917
references.citation: Neurology. 2004 Dec 14;63(11):2084-90
references.pmid: 15596754
references.citation: J Neurovirol. 2005 Jul;11(3):265-73
references.pmid: 16036806
references.citation: Clin Infect Dis. 2011 Jan 15;52(2):235-43
references.pmid: 21288850
references.citation: AIDS Res Hum Retroviruses. 2005 Aug;21(8):706-13
references.pmid: 16131310
references.citation: Neurology. 2010 Dec 7;75(23):2087-96
references.pmid: 21135382
references.citation: HIV Med. 2010 Aug;11(7):432-8
references.pmid: 20146736
references.citation: Eur J Neurol. 2011 Mar;18(3):527-34
references.pmid: 21159073
references.citation: HIV Clin Trials. 2011 Nov-Dec;12(6):333-8
references.pmid: 22189152
references.citation: AIDS Behav. 2011 Nov;15(8):1879-87
references.pmid: 21598031