Department of Psychiatry and Mental Health.
Department of Psychology, ACSENT Laboratory.
AIDS. 2019 Apr 1;33(5):815-824. doi: 10.1097/QAD.0000000000002144.
Perinatal HIV infection has adverse cognitive consequences into adolescence. However, there are no screening tools that assess risk for HIV-associated neurocognitive disorders in adolescent populations. Such screening tools are needed urgently for clinical care in resource-poor settings with a high prevalence of HIV.
To investigate the performance of the International HIV Dementia Scale (IHDS) as a screening tool for HIV-associated neurocognitive disorders in perinatally adolescents.
The current study is a quantitative, quasiexperimental design.
Perinatally HIV-infected adolescents aged 9-12 years were recruited from community health clinics into the Cape Town Adolescent Antiretroviral Cohort; matched HIV-negative controls from the same communities were enrolled. Each participant completed the IHDS and a comprehensive neuropsychological battery. The adult version of the IHDS was performed, except for two minor modifications. We evaluated the diagnostic validity of this modified instrument, the youth-IHDS (y-IHDS), using a four-step process that included sensitivity and specificity calculations, and generating receiver operating characteristic curves. Validity was measured against the youth HIV-associated diagnostic criteria.
At a cut-off score of 10 or less, the y-IHDS demonstrated good sensitivity (94%) but poor specificity (24%) for detecting all forms of neurocognitive disorders, with an acceptable area under the curve value of 0.695.
The y-IHDS requires minimal resources and is based on a screening tool for adult HIV-associated cognitive disorders that is already widely used globally. Hence, this brief, cost-efficient, and valid screening tool may be a useful addition for clinicians working in resource-poor contexts in which adolescent HIV is highly prevalent.
围产期 HIV 感染会对青少年的认知产生不良影响。然而，目前尚无评估青少年人群中 HIV 相关神经认知障碍风险的筛查工具。在资源匮乏且 HIV 流行率高的环境中，迫切需要此类筛查工具来进行临床护理。
探究国际 HIV 痴呆量表（IHDS）作为一种针对围产期青少年 HIV 相关神经认知障碍的筛查工具的性能。
本研究为定量、准实验设计。
从社区卫生诊所招募了 9-12 岁的围产期 HIV 感染青少年进入开普敦青少年抗逆转录病毒队列；从同一社区招募了相匹配的 HIV 阴性对照者。每位参与者都完成了 IHDS 和全面的神经心理学测试。采用成人版 IHDS，但有两项细微改动。我们使用包括敏感性和特异性计算以及生成受试者工作特征曲线在内的四步流程来评估这种改良工具（y-IHDS）的诊断准确性。有效性通过青少年 HIV 相关诊断标准来衡量。
在得分 10 或以下的截定点，y-IHDS 对检测所有形式的神经认知障碍的敏感性为 94%，但特异性为 24%，曲线下面积值为 0.695，具有可接受的准确性。
y-IHDS 所需资源极少，且基于一种已在全球范围内广泛使用的成人 HIV 相关认知障碍筛查工具。因此，这种简单、经济高效且有效的筛查工具可能是在青少年 HIV 高发的资源匮乏环境中工作的临床医生的有用补充。
