Assessment of neurocognitive disorders in HIV infected patients receiving combination of anti-retroviral therapy at a tertiary care hospital - An observational study

Abstract

cARTTherapy (combination antiretroviral therapy) has improved the live expectancy of people living with HIV (PLHIV). But HIV associated neurocognitive disorders (HAND) are still prevalent. One of the factors associated could be the cARTtherapy itself. The study aims to calculate the prevalence of HAND and associated risk factors in PLHIV who are on Cart therapy and to compare the efficiency of MMSE and IHDS scales in the assessment of HAND. A case-control study involving 54 PLHIV on cART therapy and 27 HIV negative controls were screened for their neurocognition by two neuropsychological tests such as MMSE and IHDS, followed by staging into Asymptomatic Neurological Impairment (ANI), Mild Neurocognitive Impairment (MND), HIV Associated Dementia (HAD) in PLHIV. Statistical analysis was done using suitable software. The overall prevalence of HAND in our study was found to be 70.37%. Prevalence estimates for specific HAND diagnoses were 57.89% ANI, 28.9% MND, and 13.1 % HAD. IHDS demonstrated good screening ability for HAND with an optimal cut-off score of 10, high sensitivity of 70% and minimal specificity. Age, male gender, low literacy, presence of comorbidities, severity of the disease, cART regimen with low CPE (CNS penetration effectiveness) score were strongly correlated. Study findings suggest that IHDS serves as a better screening tool for HAND with greater sensitivity and can facilitate further cognitive evaluation. The overall prevalence was found to be equivalent to that of the recently reported studies.