Abstract
BackgroundHIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). The prevalence of HAND in Hong Kong is not known.MethodsBetween 2013 and 2015, 98 treatment-naïve HIV-1-infected individuals were referred to and screened by the AIDS Clinical Service, Queen Elizabeth Hospital with (1) the International HIV Dementia Scale (IHDS), a screening tool that targets moderate to severe HAND, (2) the Montreal Cognitive Assessment (MoCA), a frequently used cognitive screening test and (3) the Patient Health Questionnare-9 (PHQ-9), a 9-item questionnaire that evaluates depression symptoms. Within the study period, 57 of them completed the second set of IHDS and MoCA at 6 months after baseline assessment.ResultsMost participants were male (94%), with a median age of 31 years. At baseline, 38 (39%) and 25 (26%) of them scored below the IHDS (≤10) and MoCA (25/26) cut-offs respectively. Poor IHDS performers also scored lower on MoCA (p = 0.039) but the correlation between IHDS and MoCA performance was weak (r = 0.29, p = 0.004). Up to a third of poor IHDS performers (13/38) showed moderate depression (PHQ-9 > 9). In the multivariable analysis, a lower education level (p = 0.088), a history of prior psychiatric illness (p = 0.091) and the presence of moderate depression (p = 0.079) tended to be significantly associated with poor IHDS performance.At follow-up, 54 out of 57 were on cART, of which 46 (85%) had achieved viral suppression. Their blood CD4+ T-lymphocytes and IHDS scores were higher at follow-up compared to baseline values (both p < 0.001) but their MoCA performance was similar at both assessments. Of note, 17 participants in this subgroup scored below the IHDS cut-off at both assessments.ConclusionsPoor IHDS performance, and likely cognitive impairment, was frequently observed in treatment-naïve HIV-infected individuals in our locality. A considerable proportion continued to score below the IHDS cut-off at 6 months after cART. Depression was frequently observed in this vulnerable population and was associated with poor IHDS performance.
Highlights
HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy
The introduction of combination antiretroviral therapy has changed HIV-1 infection from a life-threatening disease to a manageable chronic condition, and life expectancy of people living with HIV (PLWH) is approaching that of non-infected individuals [1]
It is estimated that the frequency of HIV associated dementia (HAD), the most severe form of HIV associated cognitive disorder (HAND), has dropped from 20 to 2% among PLWH in the combination antiretroviral therapy (cART) era
Summary
HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). While CNS opportunistic infections are rare, cognitive impairment remains common in PLWH on cART [2,3,4]. It is estimated that the frequency of HIV associated dementia (HAD), the most severe form of HIV associated cognitive disorder (HAND), has dropped from 20 to 2% among PLWH in the cART era. In Hong Kong, the population of PLWH exceeded 8000 in 2016 with around 700 new cases reported each year and the prevalence of cognitive impairment in this vulnerable population is largely unknown. In a multi-center cross-sectional study of 10 Asia-Pacific regions in 2008, cognitive impairment was reported in 12% of 647 clinic-followed PLWH, but this percentage was 23% among the 61 Hong Kong participants [6]. Estimating the local prevalence of cognitive impairment is essential for health funding, resource allocation and patient support
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