International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis

Abstract

The present study aims to systematically review the evidence on the accuracy of the International HIV Dementia Scale (IHDS) test for diagnosing human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and outline the quality and quantity of research evidence available on the accuracy of IHDS in people living with HIV. We conducted a systematic literature review, searching five databases from inception until July 2020. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of IHDS. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Fifteen cross-sectional studies, published between 2011 and 2018, met the inclusion criteria for meta-analysis. Overall, 3760 patients were included, but most studies recruited small samples. We assessed most studies as being applicable to the review question, though we had concerns about the selection of participants in three studies. The accuracy of IHDS was investigated at thirteen cut-off points (scores 6–12). The threshold of 10 is the most useful for optimal HAND screening (including asymptomatic neurocognitive disorder, symptomatic HAND, and HIV-associated dementia) with fair diagnostic accuracy.

HIV-Associated Neurocognitive Disorder (HAND): Obstacles to Early Neuropsychological Diagnosis

“…54 A recent systematic review found that the threshold of 10 is the most useful for optimal HAND screening (including ANI, symptomatic HAND, and HAD), with fair diagnostic accuracy. 57 For HAND screening, the test had a sensibility of 61.9% and a specificity of 67.5%. The sensibility was 61.8% for symptomatic HAND detection, but with a higher specificity of 73.6%.…”

Delusional Infestation: A case of Ekbom syndrome in an elderly woman with a long history of HIV

“…While cognitive assessment with MoCA showed no significant decline, the assessment with IHDS showed significant deficit, particularly in motor and psychomotor functioning, attributable to slow information processing speed as one of the most common cognitive impairments in HIV Associated Neurocognitive Disorder(HAND) (11). This suggests the specificity and strength of IHDS in screening for subcortical cognitive deficits, which are typical in HIV (12). Cognitive impairment (CI) in patients living with HIV is commonly reported.…”

Triple Burden of Neurocognitive Impairment and Co-occurring Depression and Anxiety Among People Living With HIV in Bahir Dar, Ethiopia: A Multicenter Study

“…The IHDS is the most common HIV-associated neurocognitive disorder (HAND) screening tool used in many African countries including South Africa, Uganda, and Cameroon ( 20 – 23 ). In addition, most recent systematic reviews and meta-analyses show that the IHDS has fair diagnostic accuracy in all forms of HAND (asymptomatic neurocognitive disorder, symptomatic neurocognitive, and HIV-associated dementia) ( 24 ). The presence of neurocognitive impairment was explained by the sum of a 3-item IHDS (timed finger tapping test, alternating hand sequence test, and memory-recall test) cutoff score of ≤ 10 in different studies ( 19 , 25 ).…”