Abstract
Background:Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. Furthermore, a user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI.Objective:This study aimed to identify factors associated with NCI using a large and diverse sample of PLWH and build a nomogram based on demographic, clinical, and behavioral variables.Methods:We performed Bayesian network analysis using a supervised learning technique with the Markov Blanket (MB) algorithm. Logistic regression was also conducted to obtain the adjusted regression coefficients to construct the nomogram.Results:Among 1,307 participants, 21.6% were neurocognitively impaired. During the MB analysis, age provided the highest amount of mutual information (0.0333). Logistic regression also showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with NCI. The highest possible points on the nomogram were 626, translated to a nomogram-predicted probability of NCI to be approximately 0.95. The receiver operating characteristic (ROC) curve's concordance index was 0.75, and the nomogram's calibration plot exhibited an excellent agreement between observed and predicted probabilities.Conclusion:The nomogram used variables that can be easily measured in clinical settings and, thus, easy to implement within a clinic or web-interface platform. The nomogram may help clinicians screen for patients with a high probability of having NCI and thus needing a comprehensive neurocognitive assessment for early diagnosis and appropriate management.
Highlights
The development of highly active combination antiretroviral therapy has resulted in a remarkable decline in HIV-associated morbidity and mortality [1]
Logistic regression showed that old age (>50 vs. ≤50 years) had the strongest association (OR=2.77, 95% CI=1.99-3.85) with neurocognitive impairment (NCI)
The nomogram used variables that can be measured in clinical settings and, easy to implement within a clinic or web-interface platform
Summary
The development of highly active combination antiretroviral therapy (cART) has resulted in a remarkable decline in HIV-associated morbidity and mortality [1]. The pathogenesis of NCI in people living with HIV (PLWH) is multifaceted, including direct viral replication, chronic inflammation, treatment-related adverse effects, comorbidities, and aging, and is not well recognized [11]. A number of risk factor associations with NCI have been studied in the HIV-infected population. While some studies reported older age, female gender, Hispanic ethnicity, substance use, comorbidities (depression, hepatitis-C co-infection, metabolic disorders, and anemia), high viral load, and low CD4 T-cell counts to be positively associated with NCI in PLWH [12 - 21], others reported contradicting results [22 - 28]. Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH). Studies have generated inconsistent results regarding etiological factors for NCI in PLWH. A user-friendly and readily available predictive tool is desirable in clinical practice to screen PLWH for NCI
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