Cognitive impairment risk high for patients with HIV

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CognitiveMore than half of patients with HIV who participated in a cross-sectional study screened positive for cognitive impairment, researchers in Ireland reported.

According to a Healio report, the researchers wrote that the results indicated “the necessity for a structured prospective large scale screening programme for cognitive impairment across countries with limited resources for detailed neuro-psychological analysis.

“Prevalence rates of 20% to 50% of HAND have been demonstrated in large prospective studies in the US, Europe and Australia,” Dr Patricia H McNamara, of the department of neurology at St James’s Hospital, Dublin, and colleagues wrote. “While these studies mainly conducted in western industrialised nations can give us reliable data due to the comprehensive nature of evaluations, there is a need to develop screening tools that can be used during routine care as comprehensive neuro-psychological testing is beyond the resources of most HIV clinics, especially in the developing world.”

Researchers recruited patients with HIV who were treated at HIV clinics at St James’s Hospital between December 2010 and February 2013 (n = 604). Just over half (51.5%) screened positive for cognitive impairment. Most patients were men (78.8%) and Irish (70.9%). Additionally, 49.3% were MSM. Mean patient age was 40.9 years. 83% of patients were undergoing ART, and 88.7% had achieved viral suppression.

Logistic regression showed that being born in Africa (P < .000001), endorsement of cognitive symptoms (P = .024), use of benzodiazepines (P = .00341), unemployment (P = .008) and consumption of more than 40 units of alcohol per week (P = .035) were all predictive of a positive cognitive impairment screen, the researchers wrote.

Approximately one quarter of patients tested positive for anxiety (24.5%), while 9.1% had depression.

McNamara and colleagues wrote that in addition to showing the need for national HAND screening programmes, the study showed the feasibility and ease of implementation for such programmes.

“It would add approximately 15 to 20 minutes to one annual visit and ensure that patients are being screened for the potential cognitive complications of HIV,” the researchers wrote.

Abstract
Background: HIV associated neurocognitive disorders (HAND) occurs in 20-50% of HIV positive patients. We undertook this study to assess the prevalence of a positive screen for cognitive impairment in the clinic population at our institution and to demonstrate the feasibility of implementing a screening program in routine clinical encounters.
Methods: This was a cross sectional study and patients were recruited prospectively between December 2010 and February 2013. Inclusion criteria were: HIV positive, over the age of 18, capable of giving informed consent, and had sufficient English. Patients were screened for cognitive impairment using the Brief Neurocognitive Screen.
Results: There were 604 patients recruited and a positive screen for cognitive impairment in 51.5%. The majority of the study cohort were male (78.8%), mean age was 40.9 (SD 10.2) years, 70.9% were Irish, the most common mode of transmission was men who have sex with men (49.3%), 83% were on ART and 88.7% were virally suppressed. Logistic regression showed that the main factors predictive of a positive screen for cognitive impairment were the endorsement of cognitive symptoms (p=0.024), being born in Africa (p<0.000001), the use of benzodiazepines (p=0.00341), being unemployed (p=0.008) and consumption of more than 40 units of alcohol weekly (p=0.035). There was a positive screen for depression in 9.1% and a positive screen for anxiety in 24.5%.
Conclusions: The study highlights the necessity for a structured prospective large scale screening programme for cognitive impairment across countries with limited resources and demonstrates the feasibility of easily implementing this with minimal training.

Authors
Patricia H McNamara, Robert Coen, Janice Redmond, Colin P Doherty, Colm Bergin

Healio report
Open Forum Infectious Diseases abstract


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