Risk factors for neurocognitive impairment in HIV-infected patients and comparison of different screening tools

Abstract

HIV-associated neurocognitive disorder (HAND) is relatively frequent among HIV-infected patients and is often underdiagnosed. Assessment of HAND in daily clinical practice is challenging and different tools have been proposed.Objective:To evaluate risk factors and compare different screening tools for neurocognitive impairment in HIV-infected patients. Methods:HIV-infected patients were evaluated using the International HIV-Dementia Scale (IHDS), Mini-Mental State Examination (MMSE) and a neurocognitive self-perception questionnaire recommended by the European AIDS Clinical Society. Sociodemographic, clinical and laboratory data were obtained through chart review and patient interview. Results:Among the 63 patients included, low performance on the IHDS was observed in 54.0% and IHDS score was inversely associated with age (OR 0.13; 95%CI [0.02-0.67]). Regarding cognitive self-perception, 63.5% of patients reported no impairment on the three domains covered by the questionnaire. Among those patients self-reporting no problems, 42.1% had low performance on the IHDS. None of the patients scored below the education-adjusted cut-off on the MMSE. Conclusion:IHDS scores suggestive of HAND were observed in more than half of the patients and lower scores were found among older patients. There was low agreement between the different tools, suggesting that the MMSE may be inadequate for assessing HAND. The self-assessment questionnaire had low sensitivity and might not be useful as a screening tool.

Cognitive functions in newly diagnosed patients with HIV infection in a tertiary health facility: Assessment using community screening interview for dementia

“…Chiesi and AIDs in Europe Study group [28] reported that cognitive function were worse in women with HIV infection while another study reported more severe cognitive impairment in men with HIV infection [29] . In this present study, there was no influence of gender on cognitive performance (Language, Memory, and Praxis) in the patients with HIV infection and this is keeping with the findings from some previous studies [30] , [31] , [32] . The isolated findings of better performance of the female patients with HIV infection on Attention/Concentration in this study may need to be further explored.…”

High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: a cross-sectional study

“…However, the prevalence of HAND in the current study was higher than a cross-sectional study done in Brazil (53%)(16), (53%)(4), in Botswana (38%)(8) Indonesia (51%)(26), Nigeria 30%(20), South Africa (25%) (27), South Asia (22.7%) (13) and in Ethiopia at Debre Markos North West (24.8%) (17), Dessie (36.4%) (18) and the Mekele referral hospital Northern Ethiopia 33.3% (21). The differences might be accounted to the neurovirulence strain differences and sociodemographic differences.…”

“…And this will lead them to develop serious life treating opportunistic infections in the meantime (11, 12). A study done in Singapore, Nigeria, Cameroon, Botswana, Malawi and Dessie Ethiopia indicated that being female, old age and low educational status is significantly related with HIV associated neurocognitive disorder (2, 8, 11-16), whereas, a study done in Brazil, Singapore and Northern Nigeria indicated that CD4 count less than 500 cell/mm3 was associated with HIV-associated neurocognitive disorder(1, 2, 13, 14). Moreover, a study done in South Africa in 2013 showed that highly active anti-retroviral treatment(HAART) naïve and late clinical stage of the illness was factors affecting HIV-associated neurocognitive disorder (10, 16).…”

High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: A cross-sectional study

“…Studies carried out in Singapore, Nigeria, Cameroon, Botswana, Malawi and Dessie Ethiopia indicated that being female, old age and low educational status were an independent risk factor for HIV associated neurocognitive disorder [ 2 , 6 , 9 , 10 , 18 , 21 – 23 ], whereas, studies carried out in Brazil, Singapore and Northern Nigeria indicated that CD4 count less than 500 cells/mm3 was associated with HIV-associated neurocognitive disorder [ 2 , 6 , 18 , 24 ]. Moreover, a study done in South Africa in 2013 showed that highly active anti-retroviral treatment (HAART) naïve and late clinical stage of the illness was factors affecting HIV-associated neurocognitive disorder [ 20 , 23 ]. Body mass index, depression and alcohol abuse were also found to be associated with HIV-associated neurocognitive disorder in Uganda [ 1 ].…”