Validity of the International HIV Dementia Scale in Brazil

Abstract

The International HIV Dementia Scale (IHDS) is a crosscultural screening test to detect HIV dementia. It is quick and does not require a neurologist to administer it. It was initially tested on HIV patients from the USA and Uganda, with reported sensitivity and specificity of 80 and 55%, respectively 1 . Subsequently, it was translated into different languages and validated in distinct settings 2,3 . We aimed to validate the IHDS in a Brazilian cohort of HIV patients and determine if non-clinician health professionals can reliably administer the IHDS. METHODSWe randomly selected 187 of 2,678 HIV patients to undergo a full neurological and neuropsychological assessment. The required number of patients was determined with the statistical program R. Exclusion criteria were age <18 years, current or past opportunistic central nervous system disease, current or past history of drug use or alcohol abuse and severe medical, psychiatric or neurologic disorder believed to ABSTRACT 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 nonclinician 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.Key words: Acquired Immunodeficiency Syndrome, HIV, dementia. RESUMO Distúrbios neurocognitivos associados ao HIV (HAND) ainda são comuns em pacientes usando terapia antirretroviral de alta eficácia (HAART).Testes diagnósticos para detecção de HAND são necessários para diagnóstico e terapia precoces. Nossos objetivos foram validar em uma população brasileira a escala internacional de demência pelo HIV (IHDS), já utilizada em outros países, e avaliar se pode ser confiavelmente aplicada por um profissional não médico. Avaliamos 187 pacientes com uma extensa bateria neuropsicológica. IHDS foi ministrada duas vezes (por médico e não médico). HAND foi diagnosticada em 98 indivíduos (68 em uso de HAART). A IHDS teve sensibilidade de 55% e especificidade de 80%, com pouca concordância com os testes neuropsicológicos (k 0,355) e moderada a forte concordância entre observadores (coeficiente de correlação interclasse (ICC) 0,684). HAND ainda é prevalente nos dias atuais. IHDS é um instrumento rápido ...

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

“…This fi gure is similar to the results reported by Rodrigues et al in the study that validated the IHDS in Brazil (9) . However, the percentage is less than the higher prevalence rates reported in other countries (3) (11) (19) .…”

“…When we used the strategy described by Rodrigues et al (9) of shifting the cutoff point of the IHDS to ≤11 to increase the sensitivity up to 75.7% for the detection of less severe neurocognitive impairment, we identifi ed a prevalence of 71.2% (n=79) in our patients; these fi ndings are more consistent with the previously reported literature (11) (30) .…”

“…Recently validated in Brazil, the IHDS exhibited a sensitivity of 78.5% and a specifi city of 80.8% for the identifi cation of HIV-related dementia (9) . The prevalence of HAND in the validation study was estimated to be 52.4%.…”

“…The international literature reports prevalence rates between 22.7 and 69% using current diagnostic criteria (10) (11) (12) . Limited Brazilian studies regarding the prevalence of HAND have been conducted (9) (13) (14) . Multiple factors are associated with neurocognitive disorders in HIV patients, with the most important factors as follows: age, duration of HIV infection, low CD4+ T lymphocyte counts (CD4), previous high plasmatic viral loads (VL), and psychiatric illness (10) (15) (16) .…”

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

“…The specificity and sensitivity of the IHDS for the detection of dementia with a score less than or equal to 10 are 55% and 80% respectively in the Ugandan cohort [22] [23] and 57% and 80% in the cohort US [22]. In Brazil [24], the specificity is 55% and specificity of 80%; in South Africa 45% and 79% [25]. These data have confirmed our IHDS to use as a screening tool.…”