Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Disorder

Maria Molinaro, Ned Sacktor, Gertrude Nakigozi, Aggrey Anok, James Batte, Alice Kisakye, Richard Myanja, Noeline Nakasujja, Kevin R. Robertson, Ronald H. Gray, Maria J. Wawer, Deanna Saylor

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We assessed the utility of the International HIV Dementia Scale (IHDS) in detecting HIV-associated neurocognitive disorder (HAND) in Uganda in antiretroviral (ART)-naïve and ART-experienced adults. SETTING: A longitudinal observational cohort study in Rakai, Uganda. METHODS: Three hundred ninety-nine HIV+ ART-naïve adults underwent neurological, functional status, and neuropsychological assessments including the IHDS. Three hundred twelve participants who initiated ART were re-evaluated after 2 years. HAND stages [asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD)] were determined based on Frascati criteria using local normative data. Sensitivity, specificity, and area under the ROC curve were determined for various IHDS thresholds (≤9, ≤ 9.5, and ≤10). RESULTS: At baseline, the participants' mean age was 35 years (SD ± 8), 53% were men, and 84% had less than a high school education. At baseline, sensitivity for detecting any HAND stage, symptomatic HAND [mild neurocognitive disorder, HAD], and HAD alone were maximized at IHDS ≤10 (81%, 83%, 92%, respectively). Among 312 individuals who returned for the 2-year follow-up and had initiated ART, a score of ≤10 provided a lower or equal sensitivity for detecting different stages of HAND (all HAND: 70%; symptomatic HAND: 75%; HAD: 94%). The area under the ROC curve was higher for ART-experienced versus ART-naïve individuals. CONCLUSIONS: The IHDS is a potentially useful screening tool for neurocognitive impairment in rural Uganda for both ART-naïve and ART-experienced adults. A cutoff ≤10 demonstrates higher sensitivity for more severe HAND stages compared with less severe HAND. Future studies should focus on potential modifications to the IHDS to improve its specificity.

Original languageEnglish (US)
Pages (from-to)278-283
Number of pages6
JournalJournal of acquired immune deficiency syndromes (1999)
Volume83
Issue number3
DOIs
StatePublished - Mar 1 2020

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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