Comparison of screening tools for the detection of neurocognitive impairment in HAART-treated patients

Abstract

Background : Neurocognitive impairment (NCI) and HIV-associated neurocognitive disorders (HAND) remain prevalent despite HAART. We examined sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and correct classification rate (CCR) of screening tools for the detection of NCI and HAND in HAART treated patients. Methods : We examined 101 unselected HAART-treated patients. Patients were administered the self-reported three questions (EACS Guidelines), the International HIV-Dementia Scale (IHDS), the Mini-Mental Status Examination (MMSE), and a comprehensive 6-domain (17-test) neuropsychological (NP) battery (120 minutes) that included, among others, the Digit Symbol (DS), the Trail Making Modalities (TM), and the Grooved Pegboard (GP) tests. NCI was defined according to the AAN criteria. HAND was diagnosed after exclusion of confounding conditions. Results : Our cohort was relatively healthy (mean CD4 count: 575 cells/mm 3 , undetectable plasma HIV RNA 85%). Prevalence of NCI and HAND were 39.6% (40 of 101) and 30.7% (31 of 101), respectively. Mean scores of IHDS (9.9 vs 10.8; p<0.001) and MMSE (26.8 vs 28.2; p=0.004) differed significantly between impaired and unimpaired patients, while mean three-questions scores (8.0 vs 7.0; p=0.23) did not. The three questions showed also poor sensitivity for the detection of both NCI (20%) and HAND (22%). The IHDS showed fairly good sensitivity (55%) and NPV (73.5%). Adding to the IHDS some easy to administer NP tests, i.e. TM, DS, and GP, resulted in an increase in sensitivity and NPV for the detection of NCI (table). Similar results were obtained regarding the detection of HAND (not shown in table). Conclusions : Both NCI and HAND are still very prevalent in HAART-treated patients. Among screening tools the self-reported three question show poor sensitivity. The IHDS performed better in terms of sensitivity, PPV, and NPV. Combinations of easy-to-administer NP tests with the IHDS resulted in increased sensitivity and NPV. Combining IHDS with one or two simple NP test may represent an improvement in the screening approach to the detection of both NCI and HAND. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Antinori A et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18286 http://www.jiasociety.org/index.php/jias/article/view/18286 | http://dx.doi.org/10.7448/IAS.15.6.18286