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Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale

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Abstract

HIV-associated neurocognitive disorders (HAND) persist despite great advancements in combination antiretroviral therapy (cART). The gold standard for diagnosing cognitive impairment consists of a time-consuming neuropsychological battery of tests given by a trained neuropsychologist, however in the outpatient HIV clinic this is not feasible. The International HIV Dementia Scale (IHDS) was developed to help identify individuals with cognitive impairment in the outpatient setting. The IHDS is moderately sensitive for detecting more symptomatic forms of HAND but sensitivity has been shown to be poor in mild impairment. The IHDS has not been evaluated in developed countries in large cohort populations. We conducted a prospective cross-sectional study of only HIV+ individuals in an urban clinic and evaluated the prevalence of HAND and associated risk factors for cognitive impairment using the IHDS. A total of 507 HIV+ individuals participated in the study of which the majority were male (65 %) and African American (68 %); and 41 % had cognitive impairment. On multivariate analysis, African American race (p = 2.21), older age (p = 1.03), high school education or less (p = 2.03) and depression (p = 1.05) were associated with cognitive impairment. The high prevalence of HAND in this group suggests that more severe forms of HAND persist despite cART. Identified risk factors were non-HIV-related and suggest that environmental and sociodemographic factors have a significant impact on cognitive functioning and should be given more attention. The IHDS should be further evaluated in large cohort HIV+ and HIV- populations in the United States, as there remains a significant need to identify an effective brief screening tool for cognitive impairment.

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Acknowledgments

Funding support came from the National Institute of Mental Health (NIMH) (K23MH081786) (BMA) and National Institute of Nursing Research (NINR) (R01NR012907, R01NR012657, and R01NR14449) (BMA).

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Sara Cross, Nur Önen & Amber Gase

  2. Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA

    Edgar Turner Overton

  3. Department of Neurology, Washington University School of Medicine, Box 8111, 660 South Euclid, Saint Louis, MO, 63110, USA

    Beau M. Ances

  4. Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, USA

    Beau M. Ances

  5. Department of Bioengineering and Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Beau M. Ances

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  1. Sara Cross
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  2. Nur Önen
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  3. Amber Gase
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  4. Edgar Turner Overton
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  5. Beau M. Ances
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Correspondence to Beau M. Ances.

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Cross, S., Önen, N., Gase, A. et al. Identifying Risk Factors for HIV-Associated Neurocognitive Disorders Using the International HIV Dementia Scale. J Neuroimmune Pharmacol 8, 1114–1122 (2013). https://doi.org/10.1007/s11481-013-9505-1

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