Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

Abstract

HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65%) and African American (68%); and 41% had cognitive impairment. On multivariate analysis, African American race (p=2.21), older age (p=1.03), high school education or less (p=2.03) and depression (p=1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV− populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.

Determinants of Neurocognitive Impairment in HIV in a Cohort of Patients on Antiretroviral Therapy Followed in Bangui (Central African Republic)

“…This result goes in the same direction as that presented by Bonnave in Guyana [39]. Cross et al 2013 in an article also showed a low level of education was associated with the occurrence of a NCD [36]. These findings corroborate the studies already conducted in the general population on dementia [40]- [42].…”

“…At Bicêtre, the prevalence of NCD was high (50%) with a median age of 67 years [30]. A paper presented by Cross et al also raised the link between age and the NCD [36]. For against Nakku et al in their work on NCD risk factors in the population of Uganda reported that advanced age and neurocognitive disorders association was not demonstrated [37].…”

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

“…Antiretroviral regimens with good CNS penetration such as nevirapine, efavirenz were associated with poorer neurocognitive performance according to Marra et al 31 While Cross S et al observed that cART preserves or improves cognition in HIV infected patients after 1 year, irrespective of the regimen's CPE. 32 In our study average duration on cART was 17.2 months. Majority of patients (n=26, 63.3%) having HAND were on ZLN (zidovudine, lamivudine, nevirapine).…”

Activation of Cannabinoid Type Two Receptors (CB2) Diminish Inflammatory Responses in Macrophages and Brain Endothelium

“…HAND (Letendre et al 2011; Spudich 2014) continues to be highly prevalent and the progression of HAND is associated with biomarkers of chronic immune activation driven by low levels of virus infection in monocytes and macrophages (Cross et al 2013; Marcotte et al 2013). Additional interventions further dampening HIV replication and diminishing chronic neuroinflammation are critically needed.…”

“…Despite immune recovery in individuals undergoing combination antiretroviral therapy (cART), the frequency of HIV-associated neurocognitive disorders (HAND) remains high for reasons that are not well understood (Cross et al 2013). Interruption of cART results in virus resurgence within days in macrophages, considered to be a primary viral reservoir.…”