Memory and Aging Center, Department of Neurology, University of California, San Francisco, California.
Missouri Institute of Mental Health, University of Missouri, St. Louis, Missouri, USA.
AIDS. 2018 Nov 13;32(17):2477-2483. doi: 10.1097/QAD.0000000000001968.
The International HIV Dementia Scale (IHDS) was developed as a tool to detect HIV-dementia in both industrialized and resource-limited settings. Studies employing the IHDS have produced mixed results, with recent data suggesting unusually high rates of dementia among Ugandans. This study aimed to define the performance characteristics of the IHDS in three African countries.
Cross-sectional study.
We recruited 2208 HIV-infected and 429 HIV-uninfected individuals from East Africa (Kenya n = 1384; Tanzania n = 368; Uganda n = 456) who underwent testing with the IHDS and a 30-min neuropsychological testing battery. Cognitive impairment was defined as -1SD on two of six tests or -2SD on one test compared with demographically matched controls stratified by age and education. We examined predictive capacity of the IHDS to detect cognitive impairment using receiver-operator characteristic (ROC) curve analysis.
The mean (SD) ages of the HIV-infected and HIV-uninfected groups were 39.7 (10.7) and 37.4 (10.4), respectively. Among HIV-infected individuals, 1508 (68%) were on combination antiretroviral therapy (cART), 1298 (61%) had plasma viral load less than 500 copies/ml and 884 (38%) met criteria for cognitive impairment. Using the customary IHDS cut-off of 10, 1136 (83%) of the HIV-infected participants met criteria for dementia resulting in 91% sensitivity but only 17% specificity. A modified cut-off score of 8 derived from the ROC resulted in low sensitivity (56%) and specificity (64%).
The IHDS has poor performance characteristics for the identification of cognitive impairment in East Africa. Cultural-informed and sensitive screening tests are needed to detect mild cognitive dysfunctions in developing countries.
国际艾滋病毒痴呆量表（IHDS）是作为一种在工业化和资源有限的环境中检测艾滋病毒相关痴呆的工具而开发的。采用 IHDS 的研究结果参差不齐，最近的数据表明乌干达人的痴呆率异常高。本研究旨在确定 IHDS 在三个非洲国家的表现特征。
横断面研究。
我们招募了来自东非（肯尼亚 n=1384；坦桑尼亚 n=368；乌干达 n=456）的 2208 名艾滋病毒感染者和 429 名艾滋病毒未感染者，他们接受了 IHDS 和 30 分钟神经心理测试的检测。认知障碍的定义是与按年龄和教育程度分层的匹配对照组相比，六项测试中的两项低于 -1SD 或一项低于 -2SD。我们使用接受者操作特征（ROC）曲线分析检查 IHDS 检测认知障碍的预测能力。
艾滋病毒感染者和未感染者的平均（标准差）年龄分别为 39.7（10.7）和 37.4（10.4）。在艾滋病毒感染者中，1508 名（68%）正在接受联合抗逆转录病毒治疗（cART），1298 名（61%）的血浆病毒载量低于 500 拷贝/ml，884 名（38%）符合认知障碍标准。使用传统的 IHDS 截断值 10，1136 名（83%）艾滋病毒感染者符合痴呆标准，敏感性为 91%，但特异性仅为 17%。ROC 得出的修改后的截断值 8 导致敏感性（56%）和特异性（64%）较低。
IHDS 在东非识别认知障碍方面的表现特征不佳。需要文化上有见识和敏感的筛查测试来检测发展中国家的轻度认知功能障碍。
