Marin-Webb Victor, Jessen Heiko, Kopp Ute, Jessen Arne B, Hahn Katrin
Praxis Jessen2 + Kollegen, Berlin, Germany.
Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
PLoS One. 2016 Dec 19;11(12):e0168225. doi: 10.1371/journal.pone.0168225. eCollection 2016.
HIV-associated neurocognitive disorders (HAND) are widely present among people living with HIV. Especially its milder forms, asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), remain highly prevalent worldwide. Diagnosing these conditions is subject to a time and resource consuming neuropsychological assessment. Selecting patients at a higher risk of cognitive impairment by using a simple but effective screening tool helps to organise access to further neuropsychological diagnosis. The International HIV Dementia Scale (IHDS) has until now been a well-established screening tool in African and American countries, however these populations' demographics defer significantly from ours, so using the same parameters could be ineffective.
To calculate the prevalence of this condition among people attending an HIV outpatient clinic in Berlin and to validate the use of the IHDS as a screening tool for HAND in a German-speaking population.
We screened 480 HIV-infected patients using the IHDS, 89% of them were on a stable antiretroviral treatment. Ninety of them completed a standardised neuropsychological battery of tests and a specific cognitive complaints questionnaire. The same procedure was applied to a control group of 30 HIV-negative participants. HAND diagnosis was established according to the Frascati criteria.
The overall prevalence of HAND in our cohort was 43% (20% ANI, 17% MND and 6% HIV-associated dementia). The optimal cut-off on the IHDS for detecting HAND cases was set at 11 and achieved both a sensitivity and a specificity of 80%. When specifically screening for the more severe form of HAND, HIV-associated dementia, a cut-off value of 10 offered an increase in both sensitivity (94%) and specificity (86%). The Youden Index for diagnostic accuracy was 0.6 and 0.8, respectively.
The prevalence of HAND was comparable to the reported by recent studies performed in countries with a similar economic development. The study confirms the IHDS to be a useful HAND screening tool in primary care settings and establishes new recommendations for its use in German-speaking countries.
HIV 相关神经认知障碍（HAND）在 HIV 感染者中广泛存在。尤其是其较轻的形式，无症状神经认知损害（ANI）和轻度神经认知障碍（MND），在全球范围内仍然非常普遍。诊断这些病症需要进行耗时且耗费资源的神经心理学评估。使用简单但有效的筛查工具来挑选认知障碍风险较高的患者，有助于安排进一步的神经心理学诊断。国际 HIV 痴呆量表（IHDS）迄今为止在非洲和美洲国家一直是一种成熟的筛查工具，然而这些人群的人口统计学特征与我们的有很大差异，因此使用相同的参数可能无效。
计算在柏林一家 HIV 门诊就诊的人群中这种病症的患病率，并验证 IHDS 作为德语人群中 HAND 筛查工具的有效性。
我们使用 IHDS 对 480 名 HIV 感染患者进行了筛查，其中 89%的患者正在接受稳定的抗逆转录病毒治疗。其中 90 人完成了一套标准化的神经心理学测试和一份特定的认知主诉问卷。对 30 名 HIV 阴性参与者的对照组也采用了相同的程序。根据弗拉斯卡蒂标准确立 HAND 诊断。
我们队列中 HAND 的总体患病率为 43%（20%为 ANI，17%为 MND，6%为 HIV 相关痴呆）。IHDS 检测 HAND 病例的最佳截断值设定为 11，灵敏度和特异度均达到 80%。当专门筛查更严重形式的 HAND，即 HIV 相关痴呆时，截断值为 10 时灵敏度（94%）和特异度（86%）均有所提高。诊断准确性的约登指数分别为 0.6 和 0.8。
HAND 的患病率与近期在经济发展水平相似的国家进行的研究所报告的患病率相当。该研究证实 IHDS 是基层医疗环境中一种有用的 HAND 筛查工具，并为其在德语国家的使用确立了新的建议。
