Screening for HIV-Associated Neurocognitive Disorder (HAND) in Adults Aged 50 and Over Attending a Government HIV Clinic in Kilimanjaro, Tanzania. Comparison of the International HIV Dementia Scale (IHDS) and IDEA Six Item Dementia Screen

Johanna Kellett‐Wright ,William K Gray,Marieke Dekker,Aloyce Kisoli,Charlotte Irwin ,Vanessa Yarwood,Rufus Akinyemi,Patrick Eaton,William P Howlett ,Philip C Makupa ,Catherine Dotchin ,Judith Mccartney,Richard Walker ,Sarah Urasa,Jessica Thornton,Elizabeta B Mukaetova‐Ladinska ,Aidan Flatt,Bingileki Lwezuala,Ashanti Duijinmaijer,Stella‐Maria Paddick

doi:10.1007/s10461-020-02998-9

Abstract

Validated screening tools for HIV-associated neurocognitive disorders (HAND) are lacking for the newly emergent ageing population of people living with HIV (PLWH) in sub-Saharan Africa (SSA). We aimed to validate and compare diagnostic accuracy of two cognitive screening tools, the International HIV dementia scale (IHDS), and the Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in Tanzania. A systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic in Tanzania were screened with the IHDS and IDEA. HAND were diagnosed by consensus American Academy of Neurology (AAN) criteria based on detailed clinical neuropsychological assessment. Strict blinding was maintained between screening and clinical evaluation. Both tools had limited diagnostic accuracy for HAND (area under the receiver operating characteristic (AUROC) curve 0.639–0.667 IHDS, 0.647–0.713 IDEA), which was highly-prevalent (47.0%). Accurate HAND screening tools for older PLWH in SSA are needed.

Highlights

HIV-associated neurocognitive disorders (HAND) are highly prevalent in people living with HIV (PLWH) worldwide and are associated with substantial morbidity and disability [1,2,3,4]
Older PLWH appear to be at highest risk, with up to 50% affected in high-income countries (HICs) [5]
Diagnostic accuracy was analysed for HAND, symptomatic HAND (s-HAND, Mild Neurocognitive Disorder (MND)/HIV-associated Dementia (HAD)) and HAD as these data would have clinical utility

Summary

Introduction

HIV-associated neurocognitive disorders (HAND) are highly prevalent in people living with HIV (PLWH) worldwide and are associated with substantial morbidity and disability [1,2,3,4]. Prior to widespread availability of cART, a rapidly-progressive subcortical dementia (’AIDS dementia complex’, termed HIV-associated dementia (HAD)), was commonly observed in advanced HIV/ AIDS. Evidence from both HICs and sub-Saharan Africa (SSA) suggests that cART has resulted in a milder but more prevalent, broader, clinical phenotype of cognitive deficit in HIV [8,9,10]. Diagnostic criteria for HAND have been updated to define this broader, milder spectrum of disorders on a continuum encompassing Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND) and HIV-associated Dementia (HAD), depending on severity of observed cognitive deficit and the presence, or absence of functional impairment [11]

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