Abstract
BackgroundHIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients.MethodsIn our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment.ResultsWe found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI.ConclusionOur findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV.
Highlights
IntroductionAntiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS
HIV is an infectious disease affecting 36.7 million people worldwide
We aimed to further establish an association between the Veterans Aging Cohort Study (VACS) Index and any degree of neurocognitive impairment that maybe prevalent among People Living with HIV (PLHIV) in the Coastal South Indian population
Summary
Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. The Veterans Aging Cohort Study Index (VACS Index) is an Index which creates a score that is directly proportional to the mortality risk from all causes in HIV infected and uninfected individuals [4]. It takes into account age, the traditional HIV markers (E.g. HIV-1 RNA and CD4 count) and the general indicators of organ system injury (E.g. hemoglobin, estimated Glomerular Filtration Rate (eGFR), Fibrosis-4 (FIB-4) and viral hepatitis C infection) [4]. The use of this index was validated for estimating all-cause mortality among a large, diverse sample size with at least a year exposure to ART in North America and Europe [3]
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