Evaluation of Three Brief Screening Tests for Older Patients with Mild HIVAssociated Neurocognitive Disorders in the cART Era

Abstract

Introduction: Prevalence of HIV-associated neurocognitive disorders (HAND) in the era of antiretrovirals is still high, the majority of clinical phenotypes being represented by mild forms of impairment. Therefore, adequate screening strategies are needed. We compared performance of three brief screening tools for detecting mild forms of HAND in an elderly population. Methods: Randomly selected patient over 50 years performed a complete neuropsychological evaluation, considered as the gold standard and three brief screening tools: International HIV Dementia Scale (IHDS), Montreal cognitive assessment (MOCA) and a French battery named FIMF and composed by: Frontal ability battery, Isaac set test, Memory span test and Five words test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of screening tools and possible combinations were analyzed. Results: 49 patients were tested (mean age 57, 78% men, nadir CD4 252, CD4 cell count at inclusion 616, 86% with viral load below 50 copies/ml, 18% HCV co-infected, 18% previous illicit drug use, 16% with AIDS). HAND was diagnosed in 30/49 patients (90% asymptomatic neurocognitive disorder, 10% mild neurocognitive disorder). In detecting HAND, the FIMF battery showed the best performances (sensitivity 87%, specificity 47%, PPV 72%, NPV 69%). Combination of MOCA, Isaac set test and Memory span test showed sensitivity 90%, specificity 47%, PPV 73%, NPV 75%, with a combined cut-off value of 78 for discriminating HAND. Conclusion: The combination of MOCA, Isaac set test and Memory span test showed better performances than the majority of screening tools available for detecting mild forms of HAND and should therefore be considered as a useful option for identifying patients requiring neuropsychological evaluation.