Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Disorder

Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Disorder

We assessed the utility of the International HIV Dementia Scale (IHDS) in detecting HIV-associated neurocognitive disorder (HAND) in Uganda in antiretroviral (ART)-naïve and ART-experienced adults. A longitudinal observational cohort study in Rakai, Uganda. Three hundred ninety-nine HIV+ ART-naïve a...

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Bibliographic Details
Published in:Journal of acquired immune deficiency syndromes (1999) Vol. 83; no. 3; pp. 278 - 283
Main Authors: Molinaro, Maria, Sacktor, Ned, Nakigozi, Gertrude, Anok, Aggrey, Batte, James, Kisakye, Alice, Myanja, Richard, Nakasujja, Noeline, Robertson, Kevin R., Gray, Ronald H., Wawer, Maria J., Saylor, Deanna
Format: Journal Article
Language:English
Published: United States JAIDS Journal of Acquired Immune Deficiency Syndromes 01-03-2020
Lippincott Williams & Wilkins Ovid Technologies
Subjects:
Adult
Adults
AIDS Dementia Complex - diagnosis
Anti-Retroviral Agents - adverse effects
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
Cognition
Cohort Studies
Dementia
Dementia disorders
Female
HIV
Human immunodeficiency virus
Humans
Impairment
Longitudinal Studies
Male
Neuropsychological Tests - standards
Sensitivity
Uganda
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Summary:We assessed the utility of the International HIV Dementia Scale (IHDS) in detecting HIV-associated neurocognitive disorder (HAND) in Uganda in antiretroviral (ART)-naïve and ART-experienced adults. A longitudinal observational cohort study in Rakai, Uganda. Three hundred ninety-nine HIV+ ART-naïve adults underwent neurological, functional status, and neuropsychological assessments including the IHDS. Three hundred twelve participants who initiated ART were re-evaluated after 2 years. HAND stages [asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD)] were determined based on Frascati criteria using local normative data. Sensitivity, specificity, and area under the ROC curve were determined for various IHDS thresholds (≤9, ≤ 9.5, and ≤10). At baseline, the participants' mean age was 35 years (SD ± 8), 53% were men, and 84% had less than a high school education. At baseline, sensitivity for detecting any HAND stage, symptomatic HAND [mild neurocognitive disorder, HAD], and HAD alone were maximized at IHDS ≤10 (81%, 83%, 92%, respectively). Among 312 individuals who returned for the 2-year follow-up and had initiated ART, a score of ≤10 provided a lower or equal sensitivity for detecting different stages of HAND (all HAND: 70%; symptomatic HAND: 75%; HAD: 94%). The area under the ROC curve was higher for ART-experienced versus ART-naïve individuals. The IHDS is a potentially useful screening tool for neurocognitive impairment in rural Uganda for both ART-naïve and ART-experienced adults. A cutoff ≤10 demonstrates higher sensitivity for more severe HAND stages compared with less severe HAND. Future studies should focus on potential modifications to the IHDS to improve its specificity.
ISSN:1525-4135
1944-7884
DOI:10.1097/QAI.0000000000002257