Risk factors for neurocognitive impairment in HIV-infected patients and comparison of different screening tools / Fatores de risco para alterações neurocognitvas em pacientes infectados pelo HIV e comparação de diferentes ferramentas de triagem

HIV-associated neurocognitive disorder (HAND) is relatively frequent among HIV-infected patients and is often underdiagnosed. Assessment of HAND in daily clinical practice is challenging and different tools have been proposed. Objective : To evaluate risk factors and compare different screening tools for neurocognitive impairment in HIV-infected patients. Methods : HIV-infected patients were evaluated using the International HIV-Dementia Scale (IHDS), Mini-Mental State Examination (MMSE) and a neurocognitive self-perception questionnaire recommended by the European AIDS Clinical Society. Sociodemographic, clinical and laboratory data were obtained through chart review and patient interview. Results : Among the 63 patients included, low performance on the IHDS was observed in 54.0% and IHDS score was inversely associated with age (OR 0.13; 95%CI [0.02-0.67]). Regarding cognitive self-perception, 63.5% of patients reported no impairment on the three domains covered by the questionnaire. Among those patients self-reporting no problems, 42.1% had low performance on the IHDS. None of the patients scored below the education-adjusted cut-off on the MMSE. Conclusion : IHDS scores suggestive of HAND were observed in more than half of the patients and lower scores were found among older patients. There was low agreement between the different tools, suggesting that the MMSE may be inadequate for assessing HAND. The self-assessment questionnaire had low sensitivity and might not be useful as a screening tool.

As alterações neurocognitivas associadas ao HIV (HAND) são relativamente frequentes entre pacientes infectados pelo HIV, porém são subdiagnosticadas. Avaliação de HAND na prática clínica diária é desafiador e diferentes ferramentas têm sido propostas. Objetivo : Avaliar fatores de risco e comparar diferentes ferramentas de rastreamento de alterações neurocognitivas em pacientes infectados pelo HIV. Métodos : Pacientes infectados pelo HIV foram avaliados usando a Escala Internacional de Demência pelo HIV (IHDS), Mini Exame do Estado Mental (MEEM) e um questionário de autopercepção neurocognitiva recomendado pela Sociedade Clínica Europeia de AIDS. Dados sociodemográficos, clínicos e laboratoriais foram obtidos por revisão de prontuário e entrevista com o paciente. Resultados : Entre os 63 pacientes incluídos no estudo, um baixo desempenho no IHDS foi observado em 54,0% e o escore no IHDS esteve inversamente associado à idade (OR 0,13; IC95% [0,02-0,67]). Em relação à autopercepção cognitiva, 63,5% dos pacientes não relataram nenhum prejuízo nos três domínios avaliados pelo instrumento. Nenhum paciente apresentou escore no MEEM abaixo do ponto de corte ajustado para escolaridade. Conclusão : Escores no IHDS sugestivos de HAND foram observados em mais da metade dos pacientes e valores mais baixos foram encontrados entre pacientes mais velhos. Houve pouca concordância entre os diferentes métodos de avaliação, sugerindo que o MEEM é inadequado para avaliação de HAND e o questionário de auto-avaliação tem uma baixa sensibilidade, não parecendo ser útil como ferramenta de triagem.

An exploratory study on the diagnostic cutoff value of International HIV-associated Dementia Scale in minority ethnic groups with different educational levels, in Guangxi / 中华流行病学杂志

Objective Using Intelligence Scale of Mini Mental State Estimated (MMSE) as the gold standard to determine the relevance of International HIV-associated Dementia Scale (IHDS)in minority ethnic areas in Guangxi populations with different cultural values.Corresponding boundary value related to the authenticity and reliability on IHDS were also evaluated.Methods 200 patients with HIV infection were randomly selected from the minority ethnic groups in Guangxi.For each infected person,MMSE and IHDS blind scale were tested at the same period.Using the results from MMSE scale test as the gold standard,ROC curve and IHDS scale in Guangxi minority populations with different education levels which related to the diagnosis of dementia-HIV values were determined.The value of a specific sector under the IHDS sensitivity,specificity,and internal consistency coefficients was also evaluated.Results When considering the infected person did not differ on their educational level,the IHDS scale diagnostic cutoff appeared as 8.25,while 1HDS sensitivity as 0.925,specificity as 0.731 and Kappa as 0.477 (P＜0.001).When considering the extent of cultural differences did influence the prevalence of infection,the different education groups showed different IHDS diagnostic cutoff values.People with high school,secondary school or higher education levels,the IHDS diagnosis appeared to be 8.25,when sensitivity was 0.917,specificity was 0.895 and Kappa was 0.722 (P＜0.001).People with only primary education level,the IHDS appeared to be 7.25.When sensitivity was 0.875,specificity was 0.661 and Kappa was 0.372 (P＜0.001).Conclusion The IHDS diagnostic sector in Guangxi minority groups was lower than the internationally recommended level of diagnostic cutoff value (IHDS≤ 10 points).When using IHDS to perform the HIV related dementia screening program,in the minority areas of Guangxi,culture context,the degree and difference of HIV infection should be considered,especially in using IHDS diagnostic cutoff values.