Kisakye Alice, Saylor Deanna, Sacktor Ned, Nakigozi Gertrude, Nakasujja Noeline, Robertson Kevin, Anok Aggrey, Wawer Maria, Gray Ron
a Rakai Health Sciences Program , Rakai , Uganda.
b Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
AIDS Care. 2019 Jul;31(7):836-839. doi: 10.1080/09540121.2018.1557591. Epub 2018 Dec 15.
Assessment of an individual's functional status, as measured by activities of daily living (ADL), is an essential element in the diagnosis of HIV-associated neurocognitive disorders (HAND) but individuals with cognitive impairment may not accurately report ADL. We assessed agreement between self- and caregiver-reported ADL in HIV-positive persons. Antiretroviral therapy (ART)-naïve HIV-positive persons (n = 321) and HIV-negative controls (n = 134) in Rakai, Uganda, completed neurocognitive tests and an ADL questionnaire. Co-resident relatives ("caregivers") were independently administered the ADL questionnaire to determine their perception of the participant's ADL. The relationship between neurocognitive impairment and participant-caregiver agreement was assessed using kappa statistics. Regression was used to estimate adjusted prevalence ratios (AdjPR) of participant-caregiver agreement on disability scores. Relative to HIV-negative adults, HIV-positive participants scoring at least 1 standard deviation (SD) below the norm on 2 or more neurocognitive tests were classified as having mild neurocognitive impairment and those scoring at least 2 SD below the norm on 2 or more neurocognitive tests were classified as having moderate-to-severe. Mean age was 36 years (SD 8.9), and 53% of participants were male. The rate of ADL agreement between participants and caregivers was 77% for HIV-positive and 87% for HIV-negative participants (AdjPR = 0.89, 95% CI 0.81-0.97, p = .01). Among HIV-positive participants, 41% had moderate neurocognitive impairment, 15% had severe neurocognitive impairment, and 44% were normal. For moderate neurocognitive impairment, the rate of ADL agreement was 69% and for severe neurocognitive impairment, it was 66%. Compared to non-impaired HIV-positive participants (86% ADL agreement), ADL agreement was lower with moderate impairment (AdjPR = 0.89, 95%CI 0.81-0.98, p = .023) and severe impairment (AdjPR = 0.77, 95%CI 0.63-0.95, p = .014). Gender, education and CD4 count were not associated with ADL agreement. HIV-positive persons with neurocognitive impairment have lower agreement with caregivers' reports of ADL than HIV-positive persons without cognitive impairment.
通过日常生活活动（ADL）来衡量个体的功能状态，是诊断HIV相关神经认知障碍（HAND）的重要因素，但认知受损的个体可能无法准确报告ADL。我们评估了HIV阳性者自我报告与照料者报告的ADL之间的一致性。乌干达拉凯地区未接受抗逆转录病毒治疗（ART）的HIV阳性者（n = 321）和HIV阴性对照者（n = 134）完成了神经认知测试和一份ADL问卷。共同居住的亲属（“照料者”）独立填写ADL问卷，以确定他们对参与者ADL的看法。使用kappa统计量评估神经认知障碍与参与者 - 照料者一致性之间的关系。采用回归分析来估计参与者 - 照料者在残疾评分上一致性的调整患病率比（AdjPR）。相对于HIV阴性成年人，在两项或更多项神经认知测试中得分至少比正常水平低1个标准差（SD）的HIV阳性参与者被分类为患有轻度神经认知障碍，而在两项或更多项神经认知测试中得分至少比正常水平低2个标准差的参与者被分类为患有中度至重度神经认知障碍。平均年龄为36岁（SD 8.9），53%的参与者为男性。HIV阳性参与者与照料者之间ADL一致性的比例为77%，HIV阴性参与者为87%（AdjPR = 0.89，95%CI 0.81 - 0.97，p = 0.01）。在HIV阳性参与者中，41%患有中度神经认知障碍，15%患有重度神经认知障碍，44%正常。对于中度神经认知障碍，ADL一致性比例为69%，对于重度神经认知障碍，为66%。与未受损的HIV阳性参与者（ADL一致性为86%）相比，中度受损（AdjPR = 0.89，95%CI 0.81 - 0.98，p = 0.023）和重度受损（AdjPR = 0.77，95%CI 0.63 - 0.95，p = 0.014）时ADL一致性较低。性别、教育程度和CD4细胞计数与ADL一致性无关。与没有认知障碍的HIV阳性者相比，有神经认知障碍的HIV阳性者与照料者报告的ADL一致性较低。
