Concurrent Classification Accuracy of the HIV Dementia Scale for HIV-Associated Neurocognitive Disorders in the CHARTER Cohort

Sakamoto, Maiko; Marcotte, Thomas D.; Umlauf, Anya; Franklin, Donald; Heaton, Robert K.; Ellis, Ronald J.; Letendre, Scott; Alexander, Thomas S.; McCutchan, J. Allen; Morgan, Erin E.; Woods, Steven Paul; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin B.; McArthur, Justin C.; Morgello, Susan; Simpson, David M.; Grant, Igor

doi:10.1097/qai.0b013e318278ffa4

Cited by 26 publications

(19 citation statements)

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“…The IHDS detected only about half of those who were impaired by a more comprehensive neuropsychological assessment. This is consistent with previous evidence that the IHDS is insensitive to the milder forms of HAND (Sakamoto et al , 2012) limiting its value as a screening instrument.…”

Section: Discussionsupporting

confidence: 92%

Neurocognitive impairment in HIV-1 clade C- versus B-infected individuals in Southern Brazil

et al. 2013

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HIV-1 clade C isolates show reduced Tat protein chemoattractant activity compared with clade B. This might influence neuropathogenesis by altering trafficking of monocytes into the CNS. A previous study suggested low rates of HIV-associated dementia in clade C infected individuals. The present study evaluated neurocognitive impairment rates in clade B- and C-infected individuals from the same local population. HIV+ and HIV- participants were recruited from the same geographic region in southern Brazil. We evaluated neuropsychological (NP) impairment using a screening instrument (the International HIV Dementia Scale; IHDS), as well as a Brazilian Portuguese adaptation of a comprehensive battery that has demonstrated sensitivity to HIV associated neurocognitive disorders (HAND) internationally. NP performance in controls was used to generate T-scores and impairment ratings by the global deficit score (GDS) method. Clade assignments were ascertained by sequencing pol and env. Blood and cerebrospinal fluid (CSF) were collected from all HIV+ participants. HIV+ and HIV- participants were comparable on demographic characteristics. HIV+ participants overall were more likely to be impaired than HIV- by the IHDS and the GDS. Clade B and C infected individuals were demographically similar and did not differ significantly in rates of impairment. The prevalence of pleocytosis, a marker of intrathecal cellular chemotaxis, also did not differ between clade B and C infections. Clade B and C HIV-infected individuals from the same geographic region, when ascertained using comparable methods, did not differ in their rates of neurocognitive impairment, and there was no evidence of differences in CNS chemotaxis.

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Section: Discussionsupporting

confidence: 92%

Neurocognitive impairment in HIV-1 clade C- versus B-infected individuals in Southern Brazil

et al. 2013

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“…However, the proposed raw cut-off of ≤ 10 provides a sensitivity of only 24% as shown recently by the CHARTER group(Sakamoto et al 2013), and might not identify those patients with subtle or asymptomatic neurocognitive impairment. When the cut-off score was increased to ≤ 14, the sensitivity improves (66%(Sakamoto et al 2013) – 83%(Simioni et al 2010)) at the expense of specificity. Our patient’s neurological function correlated with the fluctuations in her score.…”

Section: Discussionmentioning

confidence: 90%

CSF viral escape in a patient with HIV-associated neurocognitive disorder

et al. 2013

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“…A further study in rural Zambia was excluded because it was observed that all 48 HIV positive participants and all 15 HIV-negative controls scored positively (impaired) on the HDS [12]. The remainder comprised 15 studies of the HDS [2], [9], [23], [24], [63]–[73], ten of the IHDS [10], [25], [74]–[81], and one of both the HDS and IHDS [13]. One of the IHDS studies reported results from two populations and was considered as two separate studies in all further analyses [10].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies used standard definitions based on clinical assessment but either did not report their NP battery [9], [64], [80] or used a battery assessing fewer than five domains [13], [79], and six studies used a NP battery only [66], [70]–[73], [81]. Norms were generally based on published demographically-standardised data, but two studies collected normative data from local HIV-negative samples [24], [25], and six studies based in Africa used norms primarily derived from US populations [10], [74]–[76], [78], [79].…”

Section: Resultsmentioning

confidence: 99%

“…Norms were generally based on published demographically-standardised data, but two studies collected normative data from local HIV-negative samples [24], [25], and six studies based in Africa used norms primarily derived from US populations [10], [74]–[76], [78], [79]. Methods for quality control of the HDS or IHDS included test-retest methods [9], specialist supervision and training [25], [71], [73]–[75], [78], [79], improved standardisation [25], [71], [72], and expert panel review was used for the reference standard in some studies [10], [74]–[76].…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Review of the Screening Accuracy of the HIV Dementia Scale and International HIV Dementia Scale

et al. 2013

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BackgroundThe 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 FindingsA 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%.ConclusionBoth 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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Concurrent Classification Accuracy of the HIV Dementia Scale for HIV-Associated Neurocognitive Disorders in the CHARTER Cohort

Cited by 26 publications

References 30 publications

Neurocognitive impairment in HIV-1 clade C- versus B-infected individuals in Southern Brazil

Neurocognitive impairment in HIV-1 clade C- versus B-infected individuals in Southern Brazil

CSF viral escape in a patient with HIV-associated neurocognitive disorder

A Systematic Review of the Screening Accuracy of the HIV Dementia Scale and International HIV Dementia Scale

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