Molinaro Maria, Sacktor Ned, Nakigozi Gertrude, Anok Aggrey, Batte James, Kisakye Alice, Myanja Richard, Nakasujja Noeline, Robertson Kevin R, Gray Ronald H, Wawer Maria J, Saylor Deanna
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Rakai Health Sciences Program, Kalisizo, Uganda.
J Acquir Immune Defic Syndr. 2020 Mar 1;83(3):278-283. doi: 10.1097/QAI.0000000000002257.
We assessed the utility of the International HIV Dementia Scale (IHDS) in detecting HIV-associated neurocognitive disorder (HAND) in Uganda in antiretroviral (ART)-naïve and ART-experienced adults.
A longitudinal observational cohort study in Rakai, Uganda.
Three hundred ninety-nine HIV+ ART-naïve adults underwent neurological, functional status, and neuropsychological assessments including the IHDS. Three hundred twelve participants who initiated ART were re-evaluated after 2 years. HAND stages [asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD)] were determined based on Frascati criteria using local normative data. Sensitivity, specificity, and area under the ROC curve were determined for various IHDS thresholds (≤9, ≤ 9.5, and ≤10).
At baseline, the participants' mean age was 35 years (SD ± 8), 53% were men, and 84% had less than a high school education. At baseline, sensitivity for detecting any HAND stage, symptomatic HAND [mild neurocognitive disorder, HAD], and HAD alone were maximized at IHDS ≤10 (81%, 83%, 92%, respectively). Among 312 individuals who returned for the 2-year follow-up and had initiated ART, a score of ≤10 provided a lower or equal sensitivity for detecting different stages of HAND (all HAND: 70%; symptomatic HAND: 75%; HAD: 94%). The area under the ROC curve was higher for ART-experienced versus ART-naïve individuals.
The IHDS is a potentially useful screening tool for neurocognitive impairment in rural Uganda for both ART-naïve and ART-experienced adults. A cutoff ≤10 demonstrates higher sensitivity for more severe HAND stages compared with less severe HAND. Future studies should focus on potential modifications to the IHDS to improve its specificity.
我们评估了国际HIV痴呆量表（IHDS）在乌干达未接受抗逆转录病毒治疗（ART）和接受过ART治疗的成年人中检测HIV相关神经认知障碍（HAND）的效用。
乌干达拉凯的一项纵向观察队列研究。
399名未接受ART治疗的HIV阳性成年人接受了包括IHDS在内的神经学、功能状态和神经心理学评估。312名开始接受ART治疗的参与者在2年后重新接受评估。根据弗拉斯卡蒂标准，使用当地的正常数据确定HAND分期[无症状神经认知障碍、轻度神经认知障碍和HIV相关痴呆（HAD）]。针对不同的IHDS阈值（≤9、≤9.5和≤10）确定敏感性、特异性和ROC曲线下面积。
基线时，参与者的平均年龄为35岁（标准差±8），53%为男性，84%的人未接受过高中教育。基线时，检测任何HAND分期、有症状的HAND[轻度神经认知障碍、HAD]和单独的HAD的敏感性在IHDS≤10时达到最大值（分别为81%、83%、92%）。在312名返回进行2年随访并开始接受ART治疗的个体中，≤10的分数在检测HAND不同分期时提供了较低或相同的敏感性（所有HAND：70%；有症状的HAND：75%；HAD：94%）。接受过ART治疗的个体的ROC曲线下面积高于未接受过ART治疗的个体。
对于乌干达农村地区未接受ART治疗和接受过ART治疗的成年人，IHDS是一种潜在有用的神经认知障碍筛查工具。与较轻的HAND相比，≤10的临界值对更严重的HAND分期显示出更高的敏感性。未来的研究应关注对IHDS的潜在修改以提高其特异性。
