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Robbins RN, Scott TM, Gouse H, Marcotte TD, Rourke SB. Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity. Curr Top Behav Neurosci 2021; 50:429-478. [PMID: 32677005 DOI: 10.1007/7854_2019_117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
HIV-associated neurocognitive disorder (HAND) remains prevalent among people living with HIV (PLWH), especially the mild forms, even those with well-controlled HIV. Recommendations from the literature suggest routine and regular screening for HAND to detect it early and manage it effectively and adjust treatments, if warranted, when present. However, screening for HAND is not routinely done, as there are no current guidelines on when to screen and which test or tests to use. Furthermore, many of the available screening tools for HAND often cannot accurately detect the mild forms of HAND and require highly trained healthcare professionals to administer and score the tests, a requirement that is not feasible for those low- and middle-income countries with the highest HIV incidence and prevalence rates. The purpose of this chapter was to review recent research on screening tests to detect HAND and report on the strengths, limitations, and psychometric properties of those tests to detect HAND.
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Affiliation(s)
- Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Medical Center, New York, NY, USA.
| | - Travis M Scott
- Department of Psychology, Fordham University, The Bronx, NY, USA.,VA Palo Alto Health Care System, Sierra Pacific MIRECC, Palo Alto, CA, USA
| | - Hetta Gouse
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Thomas D Marcotte
- HIV Neurobehavioral Research Program, Center for Medicinal Cannabis Research, University of California, San Diego, San Diego, CA, USA
| | - Sean B Rourke
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto University, Toronto, ON, Canada
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López E, Steiner AJ, Smith K, Thaler NS, Hardy DJ, Levine AJ, Al-Kharafi HT, Yamakawa C, Goodkin K. Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults. APPLIED NEUROPSYCHOLOGY. ADULT 2017; 24:512-521. [PMID: 27712132 PMCID: PMC5938065 DOI: 10.1080/23279095.2016.1214835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.
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Affiliation(s)
- Enrique López
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander J. Steiner
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Psychology, California School of Professional Psychology, Alliant International University, Alhambra, California, USA
| | - Kimberly Smith
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas S. Thaler
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David J. Hardy
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Andrew J. Levine
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA
| | - Hussah T. Al-Kharafi
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Graduate School of Education and Psychology, Pepperdine University, Los Angeles, California, USA
| | - Cristina Yamakawa
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Karl Goodkin
- Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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Jimenez-Torres GJ, Wojna V, Rosario E, Hechevarría R, Alemán-Batista AM, Matos MR, Madan A, Skolasky RL, Acevedo SF. Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings. PLoS One 2017; 12:e0181253. [PMID: 28723939 PMCID: PMC5517021 DOI: 10.1371/journal.pone.0181253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 06/28/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale. METHODS AND DESIGN The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version. RESULTS The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003). CONCLUSION Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.
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Affiliation(s)
- Gladys J. Jimenez-Torres
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Valerie Wojna
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Department of Internal Medicine, Neurology Division, University of Puerto Rico, San Juan, PR, United States of America
| | - Ernesto Rosario
- Psychology Department, Ponce School of Medicine and Health Sciences, Ponce, PR, United States of America
| | - Rosa Hechevarría
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
- Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, PR, United States of America
| | - Ada M. Alemán-Batista
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
| | - Miriam Ríos Matos
- NeuroAIDS Research Program, University of Puerto Rico, San Juan, PR, United States of America
| | - Alok Madan
- The Menninger Clinic, Houston, TX, United States of America
- Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States of America
| | - Richard L. Skolasky
- School of Health Professions, University of Puerto Rico, San Juan, PR, United States of America
- Department of Orthopedic Surgery and Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States of America
| | - Summer F. Acevedo
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America
- * E-mail:
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HIV-associated neurocognitive disorders: the relationship of HIV infection with physical and social comorbidities. BIOMED RESEARCH INTERNATIONAL 2015; 2015:641913. [PMID: 25815329 PMCID: PMC4359826 DOI: 10.1155/2015/641913] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/29/2015] [Indexed: 12/14/2022]
Abstract
The prevalence of HIV (human immunodeficiency virus) associated neurocognitive disorders (HAND) will undoubtedly increase with the improved longevity of HIV-infected persons. HIV infection, itself, as well as multiple physiologic and psychosocial factors can contribute to cognitive impairment and neurologic complications. These comorbidities confound the diagnosis, assessment, and interventions for neurocognitive disorders. In this review, we discuss the role of several key comorbid factors that may contribute significantly to the development and progression of HIV-related neurocognitive impairment, as well as the current status of diagnostic strategies aimed at identifying HIV-infected individuals with impaired cognition and future research priorities and challenges.
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Vázquez-Santiago F, García Y, Rivera-Román I, Noel RJ, Wojna V, Meléndez LM, Rivera-Amill V. Longitudinal Analysis of Cerebrospinal Fluid and Plasma HIV-1 Envelope Sequences Isolated From a Single Donor with HIV Asymptomatic Neurocognitive Impairment. ACTA ACUST UNITED AC 2015; 4. [PMID: 26167513 DOI: 10.4172/2324-8955.1000135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Combined antiretroviral treatment (cART) has changed the clinical presentation of HIV-associated neurocognitive disorders (HAND) to that of the milder forms of the disease. Asymptomatic neurocognitive impairment (ANI) is now more prevalent and is associated with increased morbidity and mortality risk in HIV-1-infected people. HIV-1 envelope (env) genetic heterogeneity has been detected within the central nervous system (CNS) of individuals with ANI. Changes within env determine co-receptor use, cellular tropism, and neuropathogenesis. We hypothesize that compartmental changes are associated with HIV-1 env C2V4 during ANI and sought to analyze paired HIV-1 env sequences from plasma and cerebrospinal fluid (CSF) of a female subject undergoing long-term cART. METHODS Paired plasma and CSF samples were collected at 12-month intervals and HIV-1 env C2V4 was cloned and sequenced. RESULTS Phylogenetic analysis of paired samples consistently showed genetic variants unique to the CSF. Phenotypic prediction showed CCR5 (R5) variants for all CSF-derived sequences and showed minor X4 variants (or dual-tropic) in the plasma at later time points. Viral compartmentalization was evident throughout the study, suggesting that the occurrence of distinctive env strains may contribute to the neuropathogenesis of HAND. CONCLUSIONS Our study provides new insights about the genetic characteristics within the C2V4 of HIV-1 env that persist after long-term cART and during the course of persistent ANI.
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Affiliation(s)
- Fabián Vázquez-Santiago
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Yashira García
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Ivelisse Rivera-Román
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Richard J Noel
- Department of Biochemistry, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
| | - Valerie Wojna
- Specialized NeuroAIDS Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA ; Department of Internal Medicine, Neurology Division, University of Puerto Rico-Medical Sciences Campus, San Juan, PR 00936, USA
| | - Loyda M Meléndez
- Specialized NeuroAIDS Program, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA ; Department of Microbiology and Medical Zoology, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, 00936, USA
| | - Vanessa Rivera-Amill
- Department of Microbiology, Ponce Health Sciences University- School of Medicine/Ponce Research Institute, Ponce, PR 00716, USA
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Dang C, Wei B, Long J, Zhou M, Han X, Zhao T. Validity of the International HIV Dementia Scale as assessed in a socioeconomically underdeveloped region of Southern China: assessing the influence of educational attainment. Int J Infect Dis 2014; 33:56-61. [PMID: 25554389 DOI: 10.1016/j.ijid.2014.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/10/2014] [Accepted: 12/22/2014] [Indexed: 11/26/2022] Open
Abstract
In 2012, more than 80,000 cases of HIV infection were recorded in the Southern Chinese minority autonomous region of Guangxi Zhuang, where the occurrence of HIV-associated dementia remains high. The International HIV Dementia Scale is a relatively simple-to-administer screening scale for HIV-associated neurocognitive disorders. However, clinical experience in utilizing the scale with large Chinese samples is currently lacking, especially among individuals with limited formal schooling. In this study, a full neuropsychological evaluation the gold standard was conducted to identify the incidence/prevalence of HIV-associated neurocognitive disorders in a socioeconomically underdeveloped region of Southern China and to locate the optimal cut-off scale value using receiver operating characteristic curves. The highest Youden index of the scale was 0.450, with a corresponding cut-off point of 7.25. The sensitivity and specificity were 0.737 and 0.713, respectively. These results suggest that the scale is an effective and feasible screening tool for HIV-associated neurocognitive disorders in poorer regions of China with fewer well-educated residents.
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Affiliation(s)
- Chao Dang
- Department of Neurology and Stroke Center, the 1st Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, China
| | - Bo Wei
- Guangxi Food and Drug Administration, Road 22, Nanning, Guangxi Medical University, China 530021
| | - JianXiong Long
- Public Health College of Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Medical University, China 530021
| | - MengXiao Zhou
- Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Medical University, China 530021
| | - XinXin Han
- Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Medical University, China 530021
| | - TingTing Zhao
- Public Health College of Guangxi Medical University, Shuangyong Road 22, Nanning, Guangxi Medical University, China 530021.
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Kamminga J, Cysique LA, Lu G, Batchelor J, Brew BJ. Validity of cognitive screens for HIV-associated neurocognitive disorder: a systematic review and an informed screen selection guide. Curr HIV/AIDS Rep 2014; 10:342-55. [PMID: 24072534 PMCID: PMC3851699 DOI: 10.1007/s11904-013-0176-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Various screening tools have been proposed to identify HIV-Associated Neurocognitive Disorder (HAND). However, there has been no systematic review of their strengths and weaknesses in detecting HAND when compared to gold standard neuropsychological testing. Thirty-five studies assessing HAND screens that were conducted in the era of combination antiretroviral therapy were retrieved using standard search procedures. Of those, 19 (54 %) compared their screen to standard neuropsychological testing. Studies were characterised by a wide variation in criterion validity primarily due to non-standard definition of neurocognitive impairment, and to the demographic and clinical heterogeneity of samples. Assessment of construct validity was lacking, and longitudinal useability was not established. To address these limitations, the current review proposed a summary of the most sensitive and specific studies (>70 %), as well as providing explicit caution regarding their weaknesses, and recommendations for their use in HIV primary care settings.
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Affiliation(s)
- Jody Kamminga
- St Vincent's Clinical School, St. Vincent's Hospital Applied Medical Research Centre, The University of New South Wales, Sydney, Australia,
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Zipursky AR, Gogolishvili D, Rueda S, Brunetta J, Carvalhal A, McCombe JA, Gill MJ, Rachlis A, Rosenes R, Arbess G, Marcotte T, Rourke SB. Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature. AIDS 2013; 27:2385-401. [PMID: 23751261 PMCID: PMC3814629 DOI: 10.1097/qad.0b013e328363bf56] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) To systematically review literature on brief screening tools used to detect and differentiate between normal cognition and neurocognitive impairment and HIV-associated neurocognitive disorders (HANDs) in adult populations of persons with HIV. DESIGN A formal systematic review. METHODS We searched six electronic databases in 2011 and contacted experts to identify relevant studies published through May 2012. We selected empirical studies that focused on evaluating brief screening tools (<20 min) for neurocognitive impairment in persons with HIV. Two reviewers independently reviewed retrieved literature for potential relevance and methodological quality. Meta-analyses were completed on screening tools that had sufficient data. RESULTS Fifty-one studies met inclusion criteria; we focused on 31 studies that compared brief screening tools with reference tests. Within these 31 studies, 39 tools were evaluated and 67% used a comprehensive neuropsychological battery as a reference. The majority of these studies evaluated HIV-associated dementia (HAD). Meta-analyses demonstrated that the HIV Dementia Scale (HDS) has poor pooled sensitivity (0.48) and the International HIV Dementia Scale (IHDS) has moderate pooled sensitivity (0.62) in detecting a range of cognitive impairment. Five newer screening tools had relatively good sensitivities (>0.70); however, none of the tools differentiated HAND conditions well enough to suggest broader use. There were significant methodological shortcomings noted in most studies. CONCLUSION HDS and IHDS perform well to screen for HAD but poorly for milder HAND conditions. Further investigation, with improved methodology, is required to understand the utility of newer screening tools for HAND; further tools may need to be developed for milder HAND conditions.
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Affiliation(s)
- Amy R Zipursky
- aOntario HIV Treatment Network bUniversity of Toronto cMaple Leaf Clinic, Toronto, Ontario dSt. Michael's Hospital, Toronto, Ontario eSouthern Alberta HIV Clinic and University of Alberta, Edmonton, Alberta fSunnybrook Hospital, Toronto, Ontario, Canada gUniversity of California, San Diego, La Jolla, California, USA
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Rodrigues RA, Oliveira RL, Grinsztejn B, Silva MTT. Validity of the International HIV Dementia Scale in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:376-9. [DOI: 10.1590/0004-282x20130042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/19/2012] [Indexed: 11/22/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) remain prevalent in highly active antiretroviral therapy (HAART) era. Tests to detect HAND are needed for early diagnosis and treatment. Validity of International HIV Dementia Scale (IHDS) has been determined in different countries. The aims of this study were validate IHDS in a Brazilian cohort of HIV-patients and verify if IHDS can be reliably administered by a non-clinician health professional. One hundred and eighty-seven (187) patients were submitted to a full neuropsychological assessment. IHDS was administered twice to each patient (by a non-clinician and by a neurologist). HAND was diagnosed in 98 individuals (68 on HAART). IHDS had sensitivity of 55% and specificity of 80%. IHDS had fair agreement with neuropsychological tests (k 0.355) and moderate-to-strong agreement between different evaluators (interclass correlation coefficient (ICC) 0.684). HAND is prevalent nowadays. IHDS is quick and easy to administer, but has marginal sensitivity for the detection of HIV cognitive impairment other than dementia.
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Fialho RM, Pereira M, Mendonça N, Ouakinin S. Depressive symptoms and neurocognitive performance among HIV-infected women. Women Health 2013; 53:117-34. [PMID: 23517511 DOI: 10.1080/03630242.2013.767301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33-18.99) and 3.22 (95% CI, 1.15-9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions. The current study was supported by Abbott Laboratories, Portugal.
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Affiliation(s)
- Renata Margalho Fialho
- Association for Research and Development of the Faculty of Medicine, University of Lisbon, Portugal
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Haddow LJ, Floyd S, Copas A, Gilson RJC. A systematic review of the screening accuracy of the HIV Dementia Scale and International HIV Dementia Scale. PLoS One 2013; 8:e61826. [PMID: 23613945 PMCID: PMC3628906 DOI: 10.1371/journal.pone.0061826] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/12/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) are brief tools that have been developed to screen for and aid diagnosis of HIV-associated dementia (HAD). They are increasingly being used in clinical practice for minor neurocognitive disorder (MND) as well as HAD, despite uncertainty about their accuracy. METHODS AND FINDINGS A systematic review of the accuracy of the HDS and IHDS was conducted. Studies were assessed on Standards for Reporting Diagnostic Accuracy criteria. Pooled sensitivity, specificity, likelihood ratios (LR) and diagnostic odds ratios (DOR) were calculated for each scale as a test for HAD or MND. We retrieved 15 studies of the HDS, 10 of the IHDS, and 1 of both scales. Thirteen studies of the HDS were conducted in North America, and 7 of the IHDS studies were conducted in sub-Saharan Africa. Estimates of accuracy were highly heterogeneous between studies for the HDS but less so for the IHDS. Pooled DOR for the HDS was 7.52 (95% confidence interval 3.75-15.11), sensitivity and specificity for HAD were estimated at 68.1% and 77.9%, and sensitivity and specificity for MND were estimated at 42.0% and 91.2%. Pooled DOR for the IHDS was 3.49 (2.12-5.73), sensitivity and specificity for HAD were 74.3% and 54.7%, and sensitivity and specificity for MND were 64.3% and 66.0%. CONCLUSION Both scales were low in accuracy. The literature is limited by the lack of a gold standard, and variation in estimates of accuracy is likely to be due to differences in reference standard. There is a lack of studies comparing both scales, and they have been studied in different populations, but the IHDS may be less specific than the HDS. These rapid tests are not recommended for diagnostic use, and further research is required to inform their use in asymptomatic screening.
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Affiliation(s)
- Lewis John Haddow
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom.
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Morales D, Acevedo SF, Skolasky RL, Hechavarria R, Santiago S, De La Torre T, Maldonado E, Wojna V. Translational spatial task and its relationship to HIV-associated neurocognitive disorders and apolipoprotein E in HIV-seropositive women. J Neurovirol 2012; 18:488-502. [PMID: 22972599 DOI: 10.1007/s13365-012-0128-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/26/2012] [Accepted: 08/24/2012] [Indexed: 11/26/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) continue to be a neurological complication of HIV infection in the era of combined antiretroviral therapy. Hippocampal neurodegeneration and dysfunction occurs as a result of HIV infection, but few studies to date have assesses spatial learning and memory function in patients with HAND. We used the Memory Island (MI) test to study the effects of HIV infection, apolipoprotein E (ApoE) allele status, and cerebral spinal fluid (CSF) ApoE protein levels on spatial learning and memory in our cohort of Hispanic women. The MI test is a virtual reality-based computer program that tests spatial learning and memory and was designed to resemble the Morris Water Maze test of hippocampal function widely used in rodent studies. In the current study, HIV-seropositive women (n = 20) and controls (n = 16) were evaluated with neuropsychological (NP) tests, the MI test, ApoE, and CSF ApoE assays. On the MI, the HIV-seropositive group showed significant reduced learning and delayed memory performance compared with HIV-seronegative controls. When stratified by cognitive performance on NP tests, the HIV-seropositive, cognitively impaired group performed worse than HIV-seronegative controls in ability to learn and in the delayed memory trial. Interestingly, differences were observed in the results obtained by the NP tests and the MI test for ε4 carriers and noncarriers: NP tests showed effects of the ε4 allele in HIV-seronegative women but not HIV-seropositive ones, whereas the converse was true for the MI test. Our findings suggest that the MI test is sensitive in detecting spatial deficits in HIV-seropositive women and that these deficits may arise relatively early in the course of HAND.
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Affiliation(s)
- Diana Morales
- Department of Physiology, Pharmacology, and Toxicology, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico
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Hu X, Zhou Y, Long J, Feng Q, Wang R, Su L, Zhao T, Wei B. Diagnostic accuracy of the International HIV Dementia Scale and HIV Dementia Scale: A meta-analysis. Exp Ther Med 2012; 4:665-668. [PMID: 23170123 PMCID: PMC3501446 DOI: 10.3892/etm.2012.665] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/06/2012] [Indexed: 11/30/2022] Open
Abstract
This aim of this study was to assess the diagnostic accuracy of the International HIV Dementia Scale (IHDS) or HIV Dementia Scale (HDS) for the diagnosis of HIV-associated neurocognitive disorders (HAND). A comprehensive and systematic search was carried out in PubMed and EMBASE databases. Sensitivity, specificity, Q*-values, summary receiver operating characteristic curves and other measures of accuracy of IHDS or HDS in the diagnosis of HAND were summarized. Summary receiver operator characteristic (SROC) curve analysis for HAND data demonstrates a pooled sensitivity of 0.90 [95% confidence interval (CI), 0.88–0.91] and overall specificity of 0.96 (95% CI, 0.95–0.97) for IHDS, the Q*-value for IHDS was 0.9195 and the diagnostic odds ratio (DOR) was 162.28 (95% CI, 91.82–286.81). HDS had an overall sensitivity of 0.39 (95% CI, 0.34–0.43) and specificity of 0.90 (95% CI, 0.89–0.91), the Q*-value for HDS was 0.6321 and DOR was 5.81 (95% CI, 3.64–9.82). There was significant heterogeneity for studies that reported IHDS and HDS. This meta-analysis has shown that IHDS and HDS may offer high diagnostic performance accuracy for the detection of HAND in primary health care and resource-limited settings. IHDS and HDS may require reformed neuropsychological characterization of impairments in accordance with regional culture and language in future international studies.
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Gerena Y, Skolasky RL, Velez JM, Toro-Nieves D, Mayo R, Nath A, Wojna V. Soluble and cell-associated insulin receptor dysfunction correlates with severity of HAND in HIV-infected women. PLoS One 2012; 7:e37358. [PMID: 22629383 PMCID: PMC3358319 DOI: 10.1371/journal.pone.0037358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/19/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Blood sugar metabolism abnormalities have been identified in HIV-infected individuals and associated with HIV-associated neurocognitive disorders (HAND). These abnormalities may occur as a result of chronic HIV infection, long-term use of combined antiretroviral treatment (CART), aging, genetic predisposition, or a combination of these factors, and may increase morbidity and mortality in this population. OBJECTIVE To determine if changes in soluble and cell-associated insulin receptor (IR) levels, IR substrate-1 (IRS-1) levels, and IRS-1 tyrosine phosphorylation are associated with the presence and severity of HAND in a cohort of HIV-seropositive women. METHODS AND RESULTS This is a retrospective cross-sectional study using patient database information and stored samples from 34 HIV-seropositive women and 10 controls without history of diabetes from the Hispanic-Latino Longitudinal Cohort of Women. Soluble IR subunits [sIR, ectodomain (α) and full-length or intact (αβ)] were assayed in plasma and CSF samples by ELISA. Membrane IR levels, IRS-1 levels, and IRS-1 tyrosine phosphorylation were analyzed in CSF white cell pellets (WCP) using flow cytometry. HIV-seropositive women had significantly increased levels of intact or full-length sIR in plasma (p<0.001) and CSF (p<0.005) relative to controls. Stratified by HAND, increased levels of full-length sIR in plasma were associated with the presence (p<0.001) and severity (p<0.005) of HAND. A significant decrease in IRS-1 tyrosine-phosphorylation in the WCP was also associated with the presence (p<0.02) and severity (p<0.02) of HAND. CONCLUSIONS This study provides evidence that IR secretion is increased in HIV-seropositive women, and increased IR secretion is associated with cognitive impairment in these women. Thus, IR dysfunction may have a role in the progression of HAND and could represent a biomarker for the presence and severity of HAND.
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Affiliation(s)
- Yamil Gerena
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- School of Pharmacy, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Richard L. Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joyce M. Velez
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Dianedis Toro-Nieves
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Raul Mayo
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Departments of Physical Medicine and Rehabilitation, University of Puerto Rico, San Juan, Puerto Rico, United States of America
| | - Avindra Nath
- Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Valerie Wojna
- NeuroAIDS Specialized Neuroscience Research Program, University of Puerto Rico, San Juan, Puerto Rico, United States of America
- Internal Medicine Neurology Division, University of Puerto Rico, San Juan, Puerto Rico, United States of America
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Robbins RN, Remien RH, Mellins CA, Joska JA, Stein DJ. Screening for HIV-associated dementia in South Africa: potentials and pitfalls of task-shifting. AIDS Patient Care STDS 2011; 25:587-93. [PMID: 21919734 DOI: 10.1089/apc.2011.0154] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is an urgent need for valid, reliable, and simple-to-use screening tools for HIV-associated dementia (HAD) in South Africa, as little is known about its impact on South Africa's 5.5 million people living with HIV (PLWH). Screening for HAD in South Africa involves several challenges, including few culturally appropriate and validated screening tools, and a shortage of trained personnel to conduct screening. This study examined rates of positive HAD screens as determined by the cutoff score on the International HIV Dementia Scale (IHDS) administered by nonspecialist community health workers (CHWs) in South Africa and examined associations between positive HAD screens and common risk factors for HAD. Sixty-five Xhosa-speaking HIV-positive individuals on antiretroviral therapy (ART) with low CD4 counts and documented ART adherence problems were administered a battery of demographic, psychiatric and neurocognitive screening measures. Positive HAD screens were present in 80% of the sample. Presence of a current alcohol dependence disorder and CD4 counts of 200 or lower were significantly associated with positive HAD screens. HIV-positive South Africans on ART with low CD4 counts and ART adherence problems may be at a very high risk for HAD, highlighting the need for more routine screening and monitoring of neurocognitive functions among South Africa's millions of PLWH on ART. Future research is needed to: (1) validate IHDS performance against a gold standard neurocognitive battery for the detection of HAD among larger samples of Xhosa-speaking South Africans with ART adherence difficulties and (2) compare performance of CHW to expert health care personnel in administering the IHDS.
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Affiliation(s)
- Reuben N. Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Center, New York, New York
| | - John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Abstract
Neurocognitive impairments following central nervous system opportunistic infections and HIV-associated dementia (HAD) were common clinical features of HIV infection prior to anti-retroviral therapy. As HIV infection has evolved from an invariably fatal disease with a poor prognosis to a condition requiring long-term management, HIV-related neurocognitive disorders have been the subject of increasing research. This review will examine the recent changes in the understanding of the HIV-associated neurocognitive disorders (HAND) including the changing epidemiology, risk factors associated with its development, methods for screening for the disorders and evolving treatment options.
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17
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Joska JA, Westgarth-Taylor J, Hoare J, Thomas KG, Paul R, Myer L, Stein DJ. Validity of the International HIV Dementia Scale in South Africa. AIDS Patient Care STDS 2011; 25:95-101. [PMID: 21214343 DOI: 10.1089/apc.2010.0292] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-associated neurocognitive disorders (HAND) remain prevalent, especially in regions like South Africa where HIV prevalence is high but access to antiretroviral treatment (ART) is limited. The incidence of HIV dementia (HAD) has been halved with the use of ART, but the prevalence remains high. Appropriate brief screening tools to screen for HAD are needed in order to facilitate treatment initiation. The validity of the International HIV Dementia Scale has not been established in a region where infection with HIV clade C is predominant. The International HIV Dementia Scale (IHDS) was administered together with a detailed neuropsychological test battery to 96 HIV-positive individuals who had not received ART and who were attending primary care HIV clinics. The validity of the IHDS was established using a receiver operating characteristic (ROC) analysis. HIV-positive individuals displayed greater impairment when compared to HIV-negative controls on the IHDS and a range of neuropsychological tests. Neuropsychological tests discriminated well across HAND categories for HIV-positive individuals. In ROC analysis, the IHDS showed an area under the curve of 0.64, with a sensitivity of 45% and specificity of 79% at a cutoff score of 10. Individuals with HAD, who screened negative on the IHDS, performed poorly on some tests of executive function. These data suggest that the IHDS may have limitations as a tool to screen for HAD in South Africans infected with HIV. Variable performance in neuropsychological testing may account for false negative screens. The inclusion of brief tests of executive function in a screening battery should be considered.
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Affiliation(s)
- John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer Westgarth-Taylor
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kevin G.F. Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Robert Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, Missouri
| | - Landon Myer
- Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- International Centre for AIDS Care & Treatment Programs, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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18
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Levine AJ, Palomo M, Hinkin CH, Valdes-Sueiras M, Lopez E, Mathisen G, Donovan S, Singer EJ. A comparison of screening batteries in the detection of neurocognitive impairment in HIV-infected Spanish speakers. NEUROBEHAVIORAL HIV MEDICINE 2011; 3:79-86. [PMID: 26448691 PMCID: PMC4593057 DOI: 10.2147/nbhiv.s22553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A substantial number of Spanish-speaking individuals from Mexico and Central America are now living in the United States. These individuals are at heightened risk for HIV infection and, due to late diagnosis and limited resources, for HIV-associated neurocognitive disorders (HAND). Early detection is key, yet adequate methods for detecting HAND in Spanish speakers, especially in resource-poor areas, remains problematic. Therefore, it is necessary to identify accurate yet efficient neurocognitive screening tools that are appropriate for use in resource-limited AIDS clinics serving Spanish-speaking patients. METHODS Twenty-one Spanish-speaking, HIV-positive adults who migrated from Mexico or Central America underwent neuromedical and neurocognitive evaluation in Spanish. The concordance of three neurocognitive screening measures (the HIV Dementia Scale [HDS], the Mini-Mental State Examination [MMSE], and the NEUROPSI) with a comprehensive neuropsychological battery was examined. In addition, accuracy in detecting neurocognitive impairment using standard and alternative cutoff scores was examined. RESULTS The HDS and the NEUROPSI showed high correlation with the comprehensive neuropsychological battery. The HDS and the NEUROPSI also had the highest sensitivity (67% and 75%, respectively) and specificity (50% and 38%, respectively). Both measures also showed greater sensitivity than the MMSE to very mild forms of HAND. CONCLUSION In this small sample of HIV-positive Spanish speakers from Mexico and Central America living in the United States, the HDS and the NEUROPSI demonstrated reasonable accuracy in detecting neurocognitive impairment, while the MMSE demonstrated very poor accuracy. The HDS and the NEUROPSI were equally sensitive in detecting mild HAND. Continued test development is required to capture this disorder, especially in resource-limited settings.
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Affiliation(s)
- Andrew J Levine
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA
| | - Manuel Palomo
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA
| | - Charles H Hinkin
- Veterans Affairs Greater Los Angeles Healthcare System ; Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA
| | - Miguel Valdes-Sueiras
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA ; Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Enrique Lopez
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA ; Department of Psychiatry and Behavioral Neuroscience, Cedars-Sinai Medical Center, Los Angeles
| | - Glenn Mathisen
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA ; Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Suzanne Donovan
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA ; Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Elyse J Singer
- National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA
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Translational research in NeuroAIDS: a neuroimmune pharmacology-related course. J Neuroimmune Pharmacol 2010; 6:80-8. [PMID: 20496178 DOI: 10.1007/s11481-010-9222-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 05/11/2010] [Indexed: 01/22/2023]
Abstract
Neuroimmune pharmacology (NIP) can be considered a multidisciplinary science where areas of neuroscience, immunology, and pharmacology intersect in neurological disorders. The R25 training program titled "Translational Research in NeuroAIDS and Mental Health (TR-NAMH): An innovative mentoring program to promote diversity in NeuroAIDS Research (R25 MH080661)" at the Johns Hopkins University is a web-based interactive course with the goal to improve the capacity of high quality research by developing mentoring programs for (1) doctoral and postdoctoral candidates and junior faculty from racial and ethnic minorities and (2) non-minority individuals at the same levels, whose research focuses on NeuroAIDS disparity issues such as HIV-associated neurocognitive disorders (HAND). This web-based interactive course overcomes the limitations of traditional education such as access to expert faculty and financial burden of scientists from racial and ethnic minority groups in the field of NeuroAIDS research and NIP and identifies rich nurturing environments for investigators to support their careers. The TR-NAMH program identifies a cadre of talented students and investigators eager to commit to innovative educational and training sessions in NeuroAIDS and NIP. The interplay between NIP changes precipitated by HIV infection in the brain makes the study of HAND an outstanding way to integrate important concepts from these two fields. The course includes activities besides those related to didactic learning such as research training and long-term mentoring; hence, the newly learned topics in NIP are continually reinforced and implemented in real-time experiences. We describe how NIP is integrated in the TR-NAMH program in the context of HAND.
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Skinner S, Adewale AJ, DeBlock L, Gill MJ, Power C. Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy. HIV Med 2009; 10:246-52. [PMID: 19187172 DOI: 10.1111/j.1468-1293.2008.00679.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to compare the performance of several bedside neuropsychological tools for detection of HIV-associated neurocognitive disorder (HAND) in antiretroviral drug-exposed persons. METHODS We analysed the relative performance of the HIV Dementia Scale (HDS), International HIV Dementia Scale (IHDS) and the Mini-Mental Status Exam (MMSE) together with neuropsychological tests (Symbol-Digit, Grooved Pegboard and Trail Making) in HIV-1-seronegative subjects (HIV-; n=13) and in HIV-1-seropositive subjects with HAND (HIV+HAND; n=13) and other neurological disorders (HIV+OND; n=20). RESULTS Established neuropsychological tests consistently showed significantly poorer performance by HIV+HAND subjects compared with the other two groups. Similarly, the mean HDS and IHDS scores were lower in the HIV+HAND group compared with the other two groups (P<0.005) while the mean MMSE score did not show significant differences between the HIV+HAND and HIV+OND groups. Receiver operator characteristics curves generated from these data using predefined cut-off scores revealed that the HDS, IHDS and MMSE displayed corresponding area under the curve values of 0.82, 0.74 and 0.48, respectively (P<0.006). CONCLUSIONS The present findings indicate that the MMSE is a weak tool for diagnosing HAND in this group of patients but the HDS and IHDS demonstrate better efficiencies, although cut-off values for the HDS require reassessment in the era of effective antiretroviral therapy.
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Affiliation(s)
- S Skinner
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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