Comparison of two screening tests for HIV-Associated Neurocognitive Disorder suspected Japanese patients with respect to cART usage.

Kaoru Kami-Onaga,Hitoshi Uehara,Shusaku Haranaga,Saori Maeda,Ai Takahashi-Nakazato,Daisuke Tasato,Masao Tateyama,Gretchen Parrott,Daisuke Tominaga,Takeshi Kinjo,Hirotaka Arae,Hideta Nakamura,Kazuya Miyagi,Kyoko Miyagi,Jiro Fujita

doi:10.1371/journal.pone.0199106

Abstract

In this study, we demonstrated the pervasiveness of HIV-associated neurocognitive disorders (HAND) among a selection of Japanese patients as well as evaluated and compared the Mini Mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) for use as a screening tool among combination anti-retroviral therapy (cART)-naïve and cART experienced patients. The MMSE and the IHDS have both been used as HAND screening tests around the world with variable success. It has been reported the increased usage of cART the utility of these screening tests may have been diminished due to the decreased severity of impairment and the altered pattern of neurocognitive impairments in cART era HAND patients. It is therefore possible the MMSE and the IHDS may still be useful among cART-naïve patients even in the cART era. However, only one study has investigated and compared the screening results of the IHDS among cART-naïve and cART experienced patients. All HIV positive patients who visited, or were admitted, to the Ryukyu University Hospital between January 2009 and March 2014 were evaluated for inclusion. Selected patients (n = 49) had data without omission for all tests. The overall prevalence of HAND in our cohort was 44%. The area under the curve (AUC), for all subjects using the MMSE and the IHDS, were 0.60 and 0.69, respectively. However, the AUC among cART-naïve patients were 0.58 and 0.76 for the MMSE and the IHDS, respectively. Whereas, cART experienced patients had an AUC of 0.60 and 0.61, respectively. Overall, the MMSE demonstrated a poor screening ability for HAND, regardless of cART usage (the cut-off value of 27 had a Youden's J-Index of 0.1, in all groups). Alternatively, the IHDS was moderately useful for HAND screening among cART-naïve patients (the cut-off value of 11 had a Youden's J-Index of 0.4), but performed poorly as a screening test among cART experienced patients (the cut-off value of 11 had a Youden's J-Index of 0.1).

Highlights

HIV-associated neurocognitive disorder (HAND) is a cognitive impairment associated with HIV infection [1]
There were no significant differences in age, gender, education years, number of HAND diagnoses, and nadir CD4 counts between the combination anti-retroviral therapy (cART)-naïve and cART experienced group
The primary aim of this study investigated the ability of the Mini Mental State Examination (MMSE) and International HIV Dementia Scale (IHDS) to screen for HAND in both cART-naïve and cART experienced patients, in an effort to elucidate the impact cART has on the reliability of screening tests for HAND suspected patients

Summary

Introduction

HIV-associated neurocognitive disorder (HAND) is a cognitive impairment associated with HIV infection [1]. HAND is an important consideration during an HIV examination since it can lead to a wide variety of challenges encountered during daily activities, such as employment, automobile driving, and medication adherence [2,3,4]. In patients with HIV viral load managed by combination anti-retroviral therapy (cART), it is reported that HAND has a 20–74% prevalence rate [5,6,7] and according to the widely used diagnostic criteria, commonly known as the Frascati criteria, a neuropsychological test battery is important for an accurate HAND diagnosis [1]. A simple screening test, which can be conducted in any facility, to find patients with cognitive function disorder is required

Methods

Results

Conclusion