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Prevalence of HIV-Associated Neurocognitive Disorders using a new CogState-based screening against standardised neuropsychological assessment in an Australian HIV-infected and HIV-negative community cohort.

Prevalence of HIV-Associated Neurocognitive Disorders using a new CogState-based screening against standardised neuropsychological assessment in an Australian HIV-infected and HIV-negative community cohort.

HIV-Associated Neurocognitive Disorders (HAND) are not routinely evaluated in primary care due to lack of a screening strategy. We developed a new screening procedure to determine HAND prevalence against a standard neuropsychological (NP) test battery.

In a prospective observational study we collected complete baseline data. The screening included standard questionnaires for mood, drug and alcohol use and activities of daily living; and a newly designed 20-minute computerized CogState battery assessing 5 cognitive domains. CogState data were transformed into age-corrected z-scores. HIV+ patients with co-morbidities were not excluded to form a representative community group but excluded in HIV-group to form a local reference). Those screened with HAND, a random HIV+ with normal screen, and a random HIV- sample also completed a standard NP battery assessing eight cognitive domains. NP data were transformed into demographically-corrected T-scores. Screening and NP testing HAND used the American Academy of Neurology 2007 criteria. Participants were blinded to screening results the NP examiner was blinded to screening and HIV status.

Enrolled were 254HIV+ subjects (median age 49 years, 93% male MSM, 65% tertiary-educated, 82% on cART, median nadir CD4 270 cells/mL, 15% CDC category C); and 72 demographically matched HIV- controls. HAND screening prevalence was 28.3% (HIV-associated dementia 3.9%, mild neurocognitive impairment 14.2% and asymptomatic neurocognitive impairment (ANI) 10.2%) versus 12.5% impaired in HIV- (all ANI), (p=0.009). Of 75 who completed the standard NP, HAND prevalence in HIV+ was 51.0% by NP and 47.2% by screening (ns) The HAND screening versus NP battery sensitivity was 64% and specificity79%.

HAND prevalence ranged between 28%-51% in a well-controlled HIV+ community cohort and was significantly higher than in HIV- controls. The CogState-based screening yields HAND rate similar to those of a two-hour NP battery but has a moderate sensitivity that may be improved by developing with comprehensive demographic corrections.

Speakers: Dr Mark Bloch
Conference: ASHM 2013
Areas of Interest / Categories: AIDS 2013, HIV, Neurobiology

AIDS 2013

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