title: Minimal cognitive impairment in UK HIV-positive men who have sex with men: effect of case definitions and comparison with the general population and HIV-negative men.
abstract: BACKGROUND
  To determine the prevalence of neurocognitive impairment (NCI) in UK HIV-positive and HIV-negative men who have sex with men (MSM).
  
  
  METHODS
  HIV-positive and HIV-negative participants were recruited to a cross-sectional study from 2 London clinics and completed computer-assisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIV-associated neurocognitive disorders (HAND) and global deficit scores were used. Age- and education-adjusted neuropsychological test scores were directly compared with reference population data.
  
  
  RESULTS
  A total of 248 HIV-positive and 45 HIV-negative MSM participated. In the HIV-positive group, median time since diagnosis was 9.4 years, median CD4 count was 550 cells per cubic millimeter, and 88% were on antiretroviral therapy. Prevalence of HAND was 21.0% in HIV-positive MSM (13.7% asymptomatic neurocognitive impairment, 6.5% mild neurocognitive disorder, and 0.8% HIV-associated dementia). Using a global deficit score threshold of 0.5, the prevalence of NCI was 31.5% (when averaged over 5 neuropsychological domains) and 40.3% (over 10 neuropsychological test scores). These results were not significantly different from the HIV-negative study sample. No consistent pattern of impairment was seen in HIV-positive patients relative to general male population data (n = 380).
  
  
  CONCLUSIONS
  We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV-positive MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV-positive MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.
authors.affiliation: *Research Department of Infection and Population Health, University College London, London, United Kingdom; †Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; ‡National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy; §CogState, Melbourne, Victoria, Australia; ‖Department of Sexual Health and HIV, Royal Free London NHS Foundation Trust, London, United Kingdom; and ¶HIV I-Base, London, United Kingdom.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McDonnell
authors.forename: Lewis
authors.initials: L
authors.lastname: Haddow
authors.forename: Marina
authors.initials: M
authors.lastname: Daskalopoulou
authors.forename: Fiona
authors.initials: F
authors.lastname: Lampe
authors.forename: Andrew
authors.initials: A
authors.lastname: Speakman
authors.forename: Richard
authors.initials: R
authors.lastname: Gilson
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sherr
authors.forename: Sonali
authors.initials: S
authors.lastname: Wayal
authors.forename: John
authors.initials: J
authors.lastname: Harrison
authors.forename: Andrea
authors.initials: A
authors.lastname: Antinori
authors.forename: Paul
authors.initials: P
authors.lastname: Maruff
authors.forename: Adrian
authors.initials: A
authors.lastname: Schembri
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.forename: Alison
authors.initials: A
authors.lastname: Rodger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology* / Q000473:pathology*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011795:Surveys and Questionnaires; D055815:Young Adult