Detection of neurocognitive disorders in patients infected with Human Immunodeficiency Virus through fast screening tests

Abstract

Background: It's known that cognitive alterations are clinical characteristic of the Human Immunodeficiency Virus (HIV) infection. Exist three clinical categories; dementia associated with HIV (HAD), mild neurocognitive disorder (MND) and asymptomatic neurocognitive disorder (ANI). Fast screening tests used are HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS). Minimental test (MMSE) in subcortical disorders is questionable. The aim of this research is to identify through fast screening tests the presence of cognitive impairment, to know if there is an association with personal risk factors associated with HIV infection and with the antiretroviral regimen received. Methods & Materials: This is a prospective, analytical, research accomplished at the Rawson Hospital of Córdoba in 2016. Three screening tests (HDS, IHDS and MMSE) were performed in patients between 18 and 60 years old with reactive serology for HIV. Exclusion criteria were patients with previous or current opportunistic infections of CNS, concomitant psychiatric disorders, current use of drugs, alcoholism, traumatic brain injury (TBI) and previous neurosurgery. Results: We included 51 patients, average age 38 ± 12.2 years old with a range between 19 - 67. The 61% were men. More than 50% did not complete high school and that was associated with cognitive impartment (p: 0,03). Underweight influenced cognitive deterioration (p: 0,02). Current LTCD4 + level was <200 cells / μl in the 35.2%. The 18% of the patients were not on HAART. The 26.1% had a detectable viral load. Conclusion: We conclude that different levels of neurocognitive deterioration depends on test used. A significant association was found between the low educational level and a lower score on the HDS test. Association was found between the low LTCD4 + count and the presence of cognitive impairment in the MMSE, but not in the rest. It was found that underweight influences the presence of cognitive impairment in our sample. Most of the patients were with HAART and a low percentage had detectable viral load for HIV. Association wasńt found between detectable viral load and the development of cognitive deterioration in this sample. All treated patients had at least one antiretroviral drug in their scheme with good penetration through the BBB.