Neurocognitive screening tools in HIV/AIDS: comparative performance among patients exposed to antiretroviral therapy

Objective

The aim of the study was to compare the performance of several bedside neuropsychological tools for detection of HIV‐associated neurocognitive disorder (HAND) in antiretroviral drug‐exposed persons.

Methods

We analysed the relative performance of the HIV Dementia Scale (HDS), International HIV Dementia Scale (IHDS) and the Mini‐Mental Status Exam (MMSE) together with neuropsychological tests (Symbol‐Digit, Grooved Pegboard and Trail Making) in HIV‐1‐seronegative subjects (HIV?; n=13) and in HIV‐1‐seropositive subjects with HAND (HIV+HAND; n=13) and other neurological disorders (HIV+OND; n=20).

Results

Established neuropsychological tests consistently showed significantly poorer performance by HIV+HAND subjects compared with the other two groups. Similarly, the mean HDS and IHDS scores were lower in the HIV+HAND group compared with the other two groups (P<0.005) while the mean MMSE score did not show significant differences between the HIV+HAND and HIV+OND groups. Receiver operator characteristics curves generated from these data using predefined cut‐off scores revealed that the HDS, IHDS and MMSE displayed corresponding area under the curve values of 0.82, 0.74 and 0.48, respectively (P<0.006).

Conclusions

The present findings indicate that the MMSE is a weak tool for diagnosing HAND in this group of patients but the HDS and IHDS demonstrate better efficiencies, although cut‐off values for the HDS require reassessment in the era of effective antiretroviral therapy.