Racial Differences in Scores on the HIV Dementia Scale: Mediating Effects of Literacy and Screening Utility among Black and White Persons with HIV Disease
Objective: There are many obstacles to screening for HIV-associated neurocognitive disorders (HAND), including the complexities of sociodemographic effects on screening measures. This study examined possible racial bias on the HIV Dementia Scale (HDS) in screening for HAND among Black and White persons living with HIV (PLWH). Participants and Methods: Participants included 39 Black and 84 White PLWH who completed the HDS and a comprehensive neuropsychological battery at the same study visit. Results: Black PLWH had significantly lower raw HDS scores than white PLWH, which was mediated by lower oral word reading scores. Nevertheless, HDS scores were comparably predictive of clinical HAND diagnoses for Black and White PLWH as determined by a comprehensive battery. Conclusions: Consistent with prior literature exploring race-group differences, findings suggest that lower scores among Black PLWH compared to white PLWH on a commonly-used screening measure for HAND are partly explained by reading scores, perhaps reflecting differences in educational quality and opportunities. However, race-group differences did not affect the classification accuracy of the HDS in detecting HAND, although overall diagnostic accuracy was modest in both groups. Future work is needed to determine the optimal neurocognitive screening methods for Black PLWH and other under-represented ethnoracial groups.