International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis.

Elena Cecilia Rosca,Raluca Tudor,Mihaela Simu,Amalia Cornea,Cristian Oancea,Philippe Tadger

doi:10.3390/diagnostics11061124

Abstract

The present study aims to systematically review the evidence on the accuracy of the International HIV Dementia Scale (IHDS) test for diagnosing human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and outline the quality and quantity of research evidence available on the accuracy of IHDS in people living with HIV. We conducted a systematic literature review, searching five databases from inception until July 2020. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of IHDS. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Fifteen cross-sectional studies, published between 2011 and 2018, met the inclusion criteria for meta-analysis. Overall, 3760 patients were included, but most studies recruited small samples. We assessed most studies as being applicable to the review question, though we had concerns about the selection of participants in three studies. The accuracy of IHDS was investigated at thirteen cut-off points (scores 6–12). The threshold of 10 is the most useful for optimal HAND screening (including asymptomatic neurocognitive disorder, symptomatic HAND, and HIV-associated dementia) with fair diagnostic accuracy.

Highlights

Despite the recent advances in the immunovirological management of individuals with human immunodeficiency virus (HIV) infection, HIV-associated neurocognitive disorders (HAND) in adults are estimated to occur in between 30% and 60% of individuals [1,2,3,4,5,6]
Epidemiological studies reported that HIV-associated dementia (HAD) is rare (2–4%) [6], most patients presenting milder forms of HAND, including asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) [3,7,8]
From a total of 54 unique studies identified using the search strategy and assessed in full-text, we included in our systematic review and meta-analysis 15 studies [52,53,54,55,56,57,58,59,60,61,62,63,64,65,66]

Summary

Introduction

Despite the recent advances in the immunovirological management of individuals with human immunodeficiency virus (HIV) infection, HIV-associated neurocognitive disorders (HAND) in adults are estimated to occur in between 30% and 60% of individuals [1,2,3,4,5,6]. Epidemiological studies reported that HIV-associated dementia (HAD) is rare (2–4%) [6], most patients presenting milder forms of HAND, including asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND) [3,7,8]. A recent systematic review found that the global prevalence of HAND was 42.6%; the milder forms of cognitive impairment, including ANI and MND, accounted for approximately 88% of all HAND forms, while the most severe form, HAD, was rare [9]. The number of MND and HAD cases decreased with the level of income, current CD4 count, and proportion of ART. The prevalence of ANI increased with age, whereas the prevalence of MND and HAD decreased with age [9]

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