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Clin Infect Dis. 2016 Sep 1;63(5):687-693. doi: 10.1093/cid/ciw399. Epub 2016 Jun 19.

A Screening Strategy for HIV-Associated Neurocognitive Disorders That Accurately Identifies Patients Requiring Neurological Review.

Author information

1
Holdsworth House Medical Practice.
2
Faculty of Medicine, University of New South Wales.
3
Department of Psychology, Macquarie University.
4
Charles Perkins Centre, University of Sydney, New South Wales.
5
Monash University.
6
Psychology Department Melbourne University, Victoria.
7
St Vincent's Hospital.
8
St Vincent's Applied Medical Research Centre.
9
Neuroscience Research Australia, Sydney, New South Wales, Australia.

Abstract

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.

KEYWORDS:

HAND; HIV; neurocognitive screening

PMID:
27325690
PMCID:
PMC4981762
DOI:
10.1093/cid/ciw399
[Indexed for MEDLINE]
Free PMC Article

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