Spanish validation of the HIV dementia scale in women

Screening for HIV-Associated Neurocognitive Disorders: Sensitivity and Specificity

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.

Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults

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.

Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings

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.

HIV-associated neurocognitive disorders: the relationship of HIV infection with physical and social comorbidities

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.

Longitudinal Analysis of Cerebrospinal Fluid and Plasma HIV-1 Envelope Sequences Isolated From a Single Donor with HIV Asymptomatic Neurocognitive Impairment

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.

Validity of the International HIV Dementia Scale as assessed in a socioeconomically underdeveloped region of Southern China: assessing the influence of educational attainment

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.

Validity of cognitive screens for HIV-associated neurocognitive disorder: a systematic review and an informed screen selection guide

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.

Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature

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.

Validity of the International HIV Dementia Scale in Brazil

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.

Depressive symptoms and neurocognitive performance among HIV-infected women

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.

A systematic review of the screening accuracy of the HIV Dementia Scale and International HIV Dementia Scale

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.

Translational spatial task and its relationship to HIV-associated neurocognitive disorders and apolipoprotein E in HIV-seropositive women

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.

Diagnostic accuracy of the International HIV Dementia Scale and HIV Dementia Scale: A meta-analysis

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.

Soluble and cell-associated insulin receptor dysfunction correlates with severity of HAND in HIV-infected women

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.

Screening for HIV-associated dementia in South Africa: potentials and pitfalls of task-shifting

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.

HIV-related neurocognitive impairment--a review

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.

Validity of the International HIV Dementia Scale in South Africa

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.

A comparison of screening batteries in the detection of neurocognitive impairment in HIV-infected Spanish speakers

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.

Translational research in NeuroAIDS: a neuroimmune pharmacology-related course

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.

Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy

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.