Development of a neurocognitive test battery for HIV-associated neurocognitive disorder (HAND) screening: suggested solu
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AIDS Research and Therapy Open Access
RESEARCH
Development of a neurocognitive test battery for HIV‑associated neurocognitive disorder (HAND) screening: suggested solutions for resource‑limited clinical settings Lai Gwen Chan1*, Mei Jing Ho1, Yijun Carol Lin1, Yining Ong1 and Chen Seong Wong2
Abstract Background: Practical screening strategies are necessary to detect neurocognitive impairment of all severities in HIV populations, which remains prevalent despite highly active antiretroviral therapy and requires full neuropsychological testing for diagnosis. We aimed to develop a brief and clinically feasible battery to screen for HIV-associated neurocognitive disorders (HAND) in resource-limited settings even where English is not the native language. Methods: A total of 53 outpatients were recruited from a multi-ethnic Southeast Asian HIV-positive cohort. Performance on a neuropsychological protocol was used to define cognitive impairment, of which 28 patients (52.8%) were identified with HAND. Receiver operating characteristic analysis was used to determine the best combinations of cognitive tests for the screening battery. Results: 3 different combinations of cognitive tests that required minimal literacy, time to administer, and administrator training were found to classify HAND with fair accuracy. Montreal Cognitive Assessment (MoCA), in combination with tests of psychomotor coordination, verbal learning and speed processing, yielded area under curve scores of above 0.75, the primary outcome of receiver operating characteristic analysis. Conclusion: The 3-test combinations presented in this study appear to be promising screening options for HAND in HIV-infected patients. The addition of 2 tests to MoCA improves the overall accuracy while retaining its convenience, giving more potential for the inclusion of cognitive screening in routine clinical care. Further validation of the batteries in specific settings is warranted to determine specific screening cut-offs to a global cognitive score. Keywords: HIV-associated neurocognitive disorders, Cognitive impairment, Screening, Neuropsychology Introduction Despite the introduction of highly active antiretroviral therapy (HAART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high; up to 50% of HIV-positive individuals are estimated to experience some level of neurocognitive impairment [1]. It was observed that approximately 1 in 5 HIV-positive patients from a South Asian population can be expected *Correspondence: [email protected] 1 Department of Psychological Medicine, Tan Tock Seng Hospital, Annex 1 Building Level 3, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore Full list of author information is available at the end of the article
to be diagnosed with HAND [2]. HAND has become a chronic end-organ complication impacting quality-of-life and functional outcomes, now that survival outcomes of HIV have improved greatly with the advent of HAART [1, 3–5]. Even in its mild form, HAND is independently predictive of death [6] a
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