HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, Cape Town, South Africa.
University Teaching Hospital, Lusaka, Zambia.
Clin Infect Dis. 2021 Sep 15;73(6):1113-1118. doi: 10.1093/cid/ciab366.
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) criteria are frequently used to describe cognitive impairment in persons living with HIV (PLWH) across diverse populations globally. These criteria typically find 20-60% of PLWH meet criteria for HAND, which does not tally with clinical observations in the modern era that cognitive disorders present relatively infrequently. Most with HAND have asymptomatic neurocognitive impairment; however, the significance of low cognitive test performance without symptoms is uncertain. Methods underlying HAND criteria carry a false-positive rate that can exceed 20%. Comorbidities, education, and complex socioeconomic factors can influence cognitive test performance, further increasing the potential for misclassification. We propose a new framework to characterize cognitive impairment in PLWH that requires a clinical history and acknowledges the multifactorial nature of low cognitive test performance. This framework is intended to be applicable across diverse populations globally, be more aligned with clinical observations, and more closely represent HIV brain pathology.
人类免疫缺陷病毒（HIV）相关神经认知障碍（HAND）标准常用于描述全球不同人群中 HIV 感染者（PLWH）的认知障碍。这些标准通常发现 20-60%的 PLWH 符合 HAND 标准，但这与现代临床观察到的认知障碍相对较少的情况并不相符。大多数 HAND 患者存在无症状的神经认知障碍；然而，没有症状的低认知测试表现的意义尚不确定。HAND 标准所依据的方法存在超过 20%的假阳性率。合并症、教育程度和复杂的社会经济因素会影响认知测试表现，进一步增加了分类错误的可能性。我们提出了一种新的框架来描述 PLWH 的认知障碍，该框架需要临床病史，并承认低认知测试表现的多因素性质。该框架旨在适用于全球不同人群，更符合临床观察，并更能代表 HIV 脑病理学。
