Prevalence of HIV-associated neurocognitive disorder (HAND) in Turkey and assessment of Addenbrooke's Cognitive Examination Revised (ACE-R) test as a screening tool

HIV Med. 2021 Jan;22(1):60-66. doi: 10.1111/hiv.12957. Epub 2020 Sep 23.

Abstract

Objectives: We aimed to assess the Addenbrooke's Cognitive Examination Revised (ACE-R) and three questions (3Qs, European Aids Clinical Society Guidelines) as potential screening tools for HIV-associated neurocognitive disorder (HAND). In addition, we tried to determine the prevalence and associated factors for HAND among people living with HIV (PLWH) in Turkey.

Methods: Persons living with HIV were enrolled from two teaching hospitals between March 2018 and September 2018. Participants underwent screening tools, a neuropsychological test battery (NTB) and an assessment of activities of daily living. HAND was diagnosed according to Frascati's criteria and applying the Global Deficit Score (GDS) approach. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of ACE-R to that of the NP test battery. Factors associated with HAND were evaluated using multivariate logistic regression analysis.

Results: The study sample included 162 participants (94% male). The HAND prevalence was 45.7% [asymptomatic neurocognitive impairment (ANI), 37.7%; mild neurocognitive disorder (MND), 7.4%; HIV-associated dementia (HAD), 0.6%] according to the Frascati criteria and 31.5% (ANI, 25.9%; MND, 4.9%; HAD, 0.6%) using the GDS. In the ROC analysis, the ACE-R showed an area under the curve of 0.68 at a cut-off score of 89. The sensitivity, specificity and correct classification rate of screening tests for HAND diagnosis were as follows: ACE-R (62.2%, 67%, 64.8%) and 3Qs (10.8%, 88.6%, 53%). In multivariate analysis, only education level (adjusted odds ratio [aOR] = 0.84, 95% CI: 0.76-0.92, P ≤ 0.001) was an independent risk factor for HAND.

Conclusions: HAND is a common comorbidity in PLWH in Turkey. The sensitivities and specificities of 3Qs and the ACE-R as screening tools are lower than desired.

Keywords: Addenbrooke’s cognitive examination; CPE score; HIV-associated neurocognitive disorder; neurocognitive impairment; neuropsychological testing; screening tool.

MeSH terms

  • AIDS Dementia Complex / diagnosis*
  • AIDS Dementia Complex / epidemiology
  • Activities of Daily Living
  • Cognition / physiology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / epidemiology
  • Female
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • Humans
  • Male
  • Mass Screening / methods*
  • Neurocognitive Disorders / epidemiology*
  • Neuropsychological Tests
  • Prevalence
  • Turkey / epidemiology