A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review.
BACKGROUND
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are not routinely assessed due to the lack of an adequate screening strategy. We aimed to develop a clinically relevant screening procedure for symptomatic HAND, validated against a gold standard neuropsychological (NP) test battery.


METHODS
Representative HIV-infected (HIV+) and demographically matched HIV-uninfected (HIV-) participants in an observational study completed a standard evaluation for mood, drug and/or alcohol use, and activities of daily living and a newly designed 20-minute computerized CogState battery that assessed 5 cognitive domains. A subset completed standard NP assessment for 8 cognitive domains. HAND definition on screening and gold standard NP was determined using demographically corrected z scores and the global deficit score (≥ 0.5), applying the Frascati criteria. Participants were blinded to screening results, and the NP examiner was blinded to screening and HIV status.


RESULTS
A total of 254 HIV+ participants were enrolled-mean age, 48.9 ± 10.2 years; median nadir CD4, 270 cells/mL; tertiary educated, 54%; and HIV- controls, 72. HIV+ HAND screening prevalence was 30.7% (HIV-associated dementia, 3.2%; mild neurocognitive disorder, 12.6%; and asymptomatic neurocognitive disorder, 15.0%; HIV- group: 13.9%; P = .004). Of the 75 participants who completed the NP battery, the HAND rate in the HIV+ group was 50.9% vs 43.4% by screening (P > .50). HAND screening vs gold standard NP sensitivity was 76% and specificity was 71%. Clinically relevant HIV-associated dementia and mild neurocognitive disorder sensitivity was 100% and specificity was 98% (positive predictive value 0.92).


CONCLUSIONS
Symptomatic HAND warranting neurological review was accurately predicted using a CogState-based screening procedure.
Holdsworth House Medical Practice.|Faculty of Medicine, University of New South Wales.
Mark
M
Bloch
Department of Psychology, Macquarie University.
Jody
J
Kamminga
Holdsworth House Medical Practice.|Charles Perkins Centre, University of Sydney, New South Wales.
Avindra
A
Jayewardene
Monash University.
Michael
M
Bailey
Holdsworth House Medical Practice.|Charles Perkins Centre, University of Sydney, New South Wales.
Angela
A
Carberry
Holdsworth House Medical Practice.
Trina
T
Vincent
Holdsworth House Medical Practice.
Dick
D
Quan
Psychology Department Melbourne University, Victoria.
Paul
P
Maruff
Faculty of Medicine, University of New South Wales.|St Vincent's Hospital.|St Vincent's Applied Medical Research Centre.
Bruce
B
Brew
Faculty of Medicine, University of New South Wales.|St Vincent's Hospital.|St Vincent's Applied Medical Research Centre.|Neuroscience Research Australia, Sydney, New South Wales, Australia.
Lucette A
LA
Cysique
D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence
HAND; HIV; neurocognitive screening