Tierney Savanna M, Sheppard David P, Kordovski Victoria M, Faytell Marika P, Avci Gunes, Woods Steven Paul
Department of Psychology, University of Houston, Houston, TX, USA.
J Neurovirol. 2017 Jun;23(3):404-421. doi: 10.1007/s13365-016-0510-z. Epub 2017 Jan 20.
HIV-associated neurocognitive disorders (HAND) occur in approximately 50% of HIV-infected individuals, yet available diagnostic criteria yield varying prevalence rates. This study examined the frequency, reliability, and sensitivity to everyday functioning problems of three HAND diagnostic criteria (DSM-5, Frascati, Gisslén). Participants included 361 adults with HIV disease and 199 seronegative adults. Neurocognitive status as defined by each of the three diagnostic systems was determined via a comprehensive neuropsychological battery. Everyday functioning was evaluated through self-report and clinician ratings. Results of logistic regressions revealed an association of HIV serostatus with Frascati-defined neurocognitive impairment (p = .027, OR = 1.7[1.1, 2.7]), but not DSM-5 or Gisslén-defined criteria (ps > .05). Frascati and DSM-5 criteria demonstrated agreement on 71% of observations, Frascati and Gisslén showed agreement on 80%, and DSM-5 and Gisslén criteria showed agreement on 46%, though reliability across the three criteria was poor. Only Frascati-defined neurocognitive impairment significantly predicted everyday functioning problems (p = .002, OR = 2.3[1.4, 3.8]). However, when both neurocognitive and complaint criteria were considered, the DSM-5 guidelines demonstrated significant relationships to everyday functioning, serostatus, and also increased reliability overtime compared to neurocognitive criteria alone (all ps < .05). A subset (n = 118) of the HIV+ group was assessed again after 14.0 (2.2) months. DSM-5 criteria evidenced significantly higher rates of incident neurocognitive disorder compared to both Frascati (p = .003) and Gisslén (p = .021) guidelines, while there were fewer remitting neurocognitive disorder diagnoses when Gisslén criteria were applied to the study sample compared to Frascati (p = .04). Future studies should aim to identify gold standard biological markers (e.g., neuropathology) and clinical outcomes associated with specific diagnostic criteria.
约50%的HIV感染者会出现与HIV相关的神经认知障碍（HAND），但现有的诊断标准得出的患病率各不相同。本研究考察了三种HAND诊断标准（《精神疾病诊断与统计手册》第5版[DSM - 5]、弗拉斯卡蒂标准、吉斯伦标准）的频率、可靠性以及对日常功能问题的敏感性。参与者包括361名患有HIV疾病的成年人和199名血清学阴性的成年人。通过一套全面的神经心理学测试确定三种诊断系统各自定义的神经认知状态。通过自我报告和临床医生评分评估日常功能。逻辑回归结果显示，HIV血清状态与弗拉斯卡蒂定义的神经认知障碍存在关联（p = 0.027，比值比[OR]=1.7[1.1, 2.7]），但与DSM - 5或吉斯伦定义的标准无关（p值>0.05）。弗拉斯卡蒂和DSM - 5标准在71%的观察结果上达成一致，弗拉斯卡蒂和吉斯伦标准的一致率为80%，DSM - 5和吉斯伦标准的一致率为46%，不过这三种标准的可靠性都较差。只有弗拉斯卡蒂定义的神经认知障碍能显著预测日常功能问题（p = 0.002，OR = 2.3[1.4, 3.8]）。然而，当同时考虑神经认知和主诉标准时，DSM - 5指南显示出与日常功能、血清状态存在显著关系，并且与仅使用神经认知标准相比，随着时间推移可靠性有所提高（所有p值<0.05）。HIV阳性组的一个子集（n = 118）在14.0（2.2）个月后再次接受评估。与弗拉斯卡蒂标准（p = 0.003）和吉斯伦标准（p = 0.021）相比，DSM - 5标准显示出更高的新发神经认知障碍发生率，而将吉斯伦标准应用于研究样本时，与弗拉斯卡蒂标准相比，缓解性神经认知障碍的诊断较少（p = 0.04）。未来的研究应致力于确定与特定诊断标准相关的金标准生物学标志物（如神经病理学）和临床结局。
