Better Diagnostics Needed for Milder HIV-Associated Neurocognitive Disorders
The Montreal Cognitive Assessment and the Cogstate Brief Battery screening tests have only modest classification accuracy for assessing mild of HIV-associated neurocognitive disorders.
New data pertaining to both predictive factors and cognitive screening for HIV-associated neurocognitive disorders (HAND) were presented at the 9th International AIDS Society (IAS) Conference on HIV Science held in Paris, France.1,2
Ilaria Mastrorosa, PhD, of the National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy, and colleagues researched prevalence and predictive factors of HAND in a retrospective cross-sectional analysis of neurocognitive profiles in HIV-infected patients treated with antiretroviral therapy (ART).
The researchers collected 1289 neuropsychological assessments from 771 HIV-infected individuals between 2009 and 2016. Of these patients, 461 (35.8%) reported a cognitive complaint of memory, attention, or concentration deficits was reported. The prevalence over time of HAND was stable in patients with cognitive complaints (P at chi square for trend, 0.134), but decreased between 2013 and 2016 in patients without cognitive complaints (P <.001).
Factors associated with HAND by multivariable logistic regression were older age, lower educational level, lower CD4+ count, and detectable HIV-RNA at negative percent agreement (NPA). Patients tested more recently showed a reduced risk for HAND.
“A decreasing prevalence of HAND was observed in more recent years among patients without a cognitive complaint,” the researchers determined. “[A] better viroimmunological state was correlated to [with] a lower risk of HAND, while worse educational level and older age [was correlated with] to a higher one. Besides HIV-related factors, patient characteristics, more than treatment-associated variables, affect risk of neurocognitive impairment.”
Sean B. Rourke, PhD, of The Ontario HIV Treatment Network, Toronto, Canada, and colleagues, assessed 4 screening tests for HAND in patients with HIV: the Cogstate Brief Battery (CBB), HIV Dementia Scale (HDS), Computer Assessment of Memory and Cognitive Impairment (CAMCI), and Montreal Cognitive Assessment (MoCA).
The researchers administered the screening tests to 220 adults (86% men; mean age, 51) at 1 HIV outpatient clinic. They defined impairment as having a raw score of >10 (HDS), ≥30 percentile (CAMCI), a score of >26 (MoCA), and impairment in two or more domains (CBB). Clinical HAND diagnosis was made according to Antinori (2007) criteria independent of screening test scores. Of the participants, 129 (59%) had a clinical diagnosis of HAND (asymptomatic neurological impairment =20; mild neurocognitive disorders=94; HIV-associated dementia=15).
The researchers found that combining any 2 positive screening tests resulted in modest improvements in classification accuracy (AUC ranges: 0.736-0.758), and that all 4 screening tests were better at detecting symptomatic HAND (10% to 32% higher AUC) compared with non-symptomatic HAND.
“Our results suggest that the MoCA and CBB screening tests have only modest global classification accuracy for assessing mild HAND in people with HIV,” the research team concluded. “Work is underway in our laboratory to determine the clinical utility and generalizability of newer instruments which may have better diagnostic accuracy.”
- Mastrorosa I, Pinnetti C, Lorenzini P, et al. Prevalence over time and predictive factors of HIV-associated neurocognitive disorder (HAND) in HIV-positive patients. Presented at: IAS 2017; June 23-26, 2017; Paris, France. Poster WEPEB0481.
- Rourke SB, Rachlis A, Gill MJ, et al. Concurrent validity of four screening tests for HIV-associated neurocognitive disorders (HAND): sensitivity, specificity, and classification accuracy. Presented at: IAS 2017; June 23-26, 2017; Paris, France. Poster WEPEB0476.