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.

International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis

The present study aims to systematically review the evidence on the accuracy of the International HIV Dementia Scale (IHDS) test for diagnosing human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) and outline the quality and quantity of research evidence available on the accuracy of IHDS in people living with HIV. We conducted a systematic literature review, searching five databases from inception until July 2020. We extracted dichotomized positive and negative test results at various thresholds and calculated the sensitivity and specificity of IHDS. Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Fifteen cross-sectional studies, published between 2011 and 2018, met the inclusion criteria for meta-analysis. Overall, 3760 patients were included, but most studies recruited small samples. We assessed most studies as being applicable to the review question, though we had concerns about the selection of participants in three studies. The accuracy of IHDS was investigated at thirteen cut-off points (scores 6–12). The threshold of 10 is the most useful for optimal HAND screening (including asymptomatic neurocognitive disorder, symptomatic HAND, and HIV-associated dementia) with fair diagnostic accuracy.

HIV-Dementia Scale as a screening tool for the detection of subcortical cognitive deficits: validation of the Italian version

Mini-Mental State Examination (MMSE) lacks of sensitivity in detecting cognitive deficits associated with subcortical damage. The HIV-Dementia Scale (HDS), a screening tool originally created for detecting cognitive impairment due to subcortical damage in HIV + patients, has proved to be useful in other neurological diseases. Until now, an Italian version of the HDS is not available. We aimed at: (1) validating the HDS Italian version (HDS-IT) in a cohort of cognitively healthy subjects (CN); (2) exploring the suitability of HDS-IT in detecting cognitive impairment due to subcortical damage (scCI). The psychometric properties of the HDS-IT were assessed in 180 CN (mean age 67.6 ± 8.3, range 41–84) with regard to item-total correlation, test–retest reliability and convergent validity with MMSE. Item-total correlations ranged 0.44–0.72. Test–retest reliability was 0.70 (p < 0.001). The HDS-IT scores were positively associated with MMSE score (rS = 0.49, p < 0.001). Then, both the HDS-IT and the MMSE were administered to 44 scCI subjects (mean age 64.9 ± 10.6, range 41–84). Mean HDS-IT total score was close to the original version and significantly lower in the scCI group compared to CN (8.6 ± 3.6 vs. 12.6 ± 2.5, p < 0.001). ROC analysis yielded an optimal cutoff value of 11, with sensitivity of 0.70 and specificity of 0.82. Patients showed poorer scores on HDS-IT compared to CN (12.6 ± 2.5 vs. 8.6 ± 3.6, p < 0.001). Our results support the use of HDS-IT as a screening tool suitable for detecting cognitive deficits with prevalent subcortical pattern, being complementary to MMSE in clinical practice.

Association between education level and HIV-associated neurocognitive disorder: a systematic review and meta-analysis

In the era of antiretroviral treatment, human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is common in HIV-positive (HIV+) patients, with an incidence of 30–50%. The relationship between education level and HAND has been evaluated in some studies, however, the results were inconsistent. The aim of this meta-analysis was to provide compelling evidence on the association between education level and the risk of HAND. Reports were searched for in the databases of Medline, Embase and PsyclNFO. Studies evaluating the relationship between education level and HAND in adult HIV+ patients were included. The pooled odds ratio/risk ratio was analysed by using the random-effects model. Two subgroup analyses were performed according to the adjustment of educational level in the neurocognitive impairment assessment and the income level. In total, 18 studies were included. Six studies and 12 studies reported education level as the continuous variable and categorical variable, respectively. The methods used for the assessment of neurocognitive impairment in included studies were neuropsychological battery tests (n = 10), HIV Dementia Scale (n = 1), the International HIV Dementia Scale (n = 6) and the Chinese version of the Montreal Cognitive Assessment (n = 1). The result showed that the risk of HAND in HIV+ patients who have lower education attainment was significantly higher than that in HIV+ patients who have higher education attainment. In conclusion, this meta-analysis demonstrated that HIV+ patients who have low education attainment carry higher risk of developing HAND compared with HIV+ patients who have high education attainment. This study highlighted the importance of early neurological screening for HIV+ patients who have low education level.

Detección de trastornos neurocognitivos en pacientes infectados por HIV mediante pruebas rápidas de cribado

Introducción: Los trastornos neurocognitivos asociados con el HIV (HAND, por sus siglas en inglés) son altamente prevalentes entre las personas que viven con el virus. Existen tres categorías: demencia asociada a HIV, deterioro neurocognitivo leve y trastorno cognitivo asintomático. Diferentes pruebas de cribado son utilizadas para detectarlos: HIV Dementia Scale (HDS), International Dementia Scale (IHDS) y Mini Mental Test (MMSE). Objetivo: Identificar mediante tres pruebas la presencia de trastornos cognitivos en pacientes infectados con HIV y su relación con diferentes factores de riesgo. Métodos: Estudio prospectivo analítico. Criterios de exclusión: neuroinfecciones, patologías psiquiátricas, uso de drogas de abuso, alcoholismo, TCE y antecedentes de neurocirugía. Resultados: Se incluyeron 51 pacientes entre 18 y 67 años. La prevalencia de HAND fue 25,5%. Presentaban deterioro neurocognitivo: el 66% HDS, 14% IHDS y 29% MMSE; y demencia el 73% HDS, 29% IHDS y 7% MMSE. Se encontró asociación entre HAND y diferentes factores de riego, como edad, desnutrición, nivel instructivo bajo, ≥ tiempo desde el diagnóstico de la infección, bajo recuento de LTCD4+, carga viral detectable y tiempo de inicio de TARV. El 100% de los pacientes tenía al menos un antirretroviral con alta penetración de la barrera hematoencefálica. Conclusiones: Los diferentes grados de deterioro neurocognitivo variaron según la prueba utilizada. Todos los pacientes tratados tenían en su esquema al menos un antirretroviral que atraviesa la barrera hematoencefálica. Factores de riesgo como edad, bajo nivel educativo, bajo peso, carga viral detectable, menor recuento de LTCD4 y tiempo de inicio TARV se asociaron a diferentes grados de deterioro neurocognitivo.