Screening for HIV-associated neurocognitive disorders in perinatally infected adolescents: Youth-International HIV Dementia Scale validation

Nicole J. Phillips, Kevin G.F. Thomas, Landon Myer, Ned Sacktor, Heather J. Zar, Dan J. Stein, Jacqueline Hoare

Research output: Contribution to journalArticlepeer-review

Abstract

Context:Perinatal HIV infection has adverse cognitive consequences into adolescence. However, there are no screening tools that assess risk for HIV-associated neurocognitive disorders in adolescent populations. Such screening tools are needed urgently for clinical care in resource-poor settings with a high prevalence of HIV.Objective:To investigate the performance of the International HIV Dementia Scale (IHDS) as a screening tool for HIV-associated neurocognitive disorders in perinatally adolescents.Design:The current study is a quantitative, quasiexperimental design.Methods:Perinatally HIV-infected adolescents aged 9-12 years were recruited from community health clinics into the Cape Town Adolescent Antiretroviral Cohort; matched HIV-negative controls from the same communities were enrolled. Each participant completed the IHDS and a comprehensive neuropsychological battery. The adult version of the IHDS was performed, except for two minor modifications. We evaluated the diagnostic validity of this modified instrument, the youth-IHDS (y-IHDS), using a four-step process that included sensitivity and specificity calculations, and generating receiver operating characteristic curves. Validity was measured against the youth HIV-associated diagnostic criteria.Results:At a cut-off score of 10 or less, the y-IHDS demonstrated good sensitivity (94%) but poor specificity (24%) for detecting all forms of neurocognitive disorders, with an acceptable area under the curve value of 0.695.Conclusion:The y-IHDS requires minimal resources and is based on a screening tool for adult HIV-associated cognitive disorders that is already widely used globally. Hence, this brief, cost-efficient, and valid screening tool may be a useful addition for clinicians working in resource-poor contexts in which adolescent HIV is highly prevalent.

Original languageEnglish (US)
Pages (from-to)815-824
Number of pages10
JournalAIDS
Volume33
Issue number5
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Keywords

  • HIV-associated neurocognitive disorders
  • International HIV Dementia Scale
  • children and adolescents
  • perinatally HIV infected
  • scale validation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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