Ratnayake Aneeka, Cysique Lucette A, Rourke Sean B
Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Northeastern University, Roux Institute, Portland, ME, USA.
AIDS Behav. 2025 Apr 28. doi: 10.1007/s10461-025-04711-0.
Diagnosing HIV-associated neurocognitive disorder (HAND) is a complex process aimed at determining the role of HIV versus other causes of neurocognitive impairment. In treated people with living long-term HIV infection, this process is further complicated by the presence of multiple medical and psychiatric comorbidities and varied educational history. Evidence-based research is therefore needed to refine the 2007 HAND diagnostic criteria on how to consider multimorbidity in making differential diagnoses. This is the case for presence of academic difficulties versus diagnosis of learning disabilities (LD), which have not been systematically studied in relation to HAND, and especially in relation to the presence of cognitive and depressive symptoms. The current study included 903 people with HIV referred for a comprehensive neuropsychological assessment of HAND at the Neurobehavioural Clinical-Research Unit (St. Michael's Hospital in Toronto, ON, Canada). Pre-morbid ability was assessed prior to standard testing and participants were classified into LD groups: No learning disabilities (n = 474), academic difficulties (n = 352) or diagnosed learning disability (LD, n = 77). The neuropsychological test battery assessed domains of complex attention, learning and memory, psychomotor efficiency, and executive functioning, and performance was adjusted with demographic corrections. Neurocognitive impairment (NCI) status was determined using the global deficit score method (GDS ≥ 0.5 detecting at least mild global NCI). Depressive symptoms were assessed with the Beck Depression Inventory (BDI), and cognitive symptoms with the Patient's Assessment of Own Functioning (PAOFI). Logistic regression models were used to assess odds of NCI in the three groups while considering main and interactive effects of clinically relevant depression (BDI > 10) or elevated cognitive symptoms (PAOFI > 3). Only LD diagnosis was significantly associated with increased odds of NCI, OR = 1.90, 95% CI (1.15, 3.14). In the same model, both cognitive symptoms, OR = 1.97, 95% CI (1.50, 2.58), and depression symptoms OR = 1.39, 95% CI (1.06, 1.82) were also significantly associated with increased odds of NCI, but not their interaction. Diagnosis of LD, but not academic difficulties alone, is associated with increased odds of NCI among treated persons living with HIV who are clinically referred. While this was in part independent of depression and cognitive symptoms, adults with HIV and LD diagnosis who had high depression and cognitive symptoms had greatest odds of NCI. These findings assist in the refinement of the current HAND diagnostic guidelines.
诊断人类免疫缺陷病毒相关神经认知障碍（HAND）是一个复杂的过程，旨在确定HIV与其他神经认知障碍病因之间的关系。在长期感染HIV且接受治疗的人群中，由于存在多种医学和精神疾病合并症以及不同的教育背景，这一过程变得更加复杂。因此，需要基于证据的研究来完善2007年HAND诊断标准中关于在进行鉴别诊断时如何考虑多重疾病的内容。学术困难与学习障碍（LD）诊断的情况就是如此，目前尚未针对HAND系统地研究过这两者的关系，尤其是与认知和抑郁症状的关系。本研究纳入了903名因HAND接受全面神经心理学评估而被转诊至神经行为临床研究单位（加拿大安大略省多伦多市圣迈克尔医院）的HIV感染者。在标准测试之前评估病前能力，并将参与者分为LD组：无学习障碍（n = 474）、学术困难（n = 352）或已确诊学习障碍（LD，n = 77）。神经心理学测试组合评估了复杂注意力、学习和记忆、心理运动效率以及执行功能等领域，并根据人口统计学校正对测试结果进行了调整。使用全球缺陷评分法（GDS≥0.5表示至少存在轻度全球神经认知障碍）确定神经认知障碍（NCI）状态。使用贝克抑郁量表（BDI）评估抑郁症状，使用患者自我功能评估量表（PAOFI）评估认知症状。使用逻辑回归模型评估三组中NCI的几率，同时考虑临床相关抑郁（BDI>10）或认知症状加重（PAOFI>3）的主要和交互作用。只有LD诊断与NCI几率增加显著相关，比值比（OR）= 1.90，95%置信区间（CI）（1.15，3.14）。在同一模型中，认知症状（OR = 1.97，95% CI（1.50，2.58））和抑郁症状（OR = 1.39，95% CI（1.06，1.82））也与NCI几率增加显著相关，但它们之间没有交互作用。在临床转诊的HIV感染者中，LD诊断而非单纯的学术困难与NCI几率增加相关。虽然这在一定程度上独立于抑郁和认知症状，但抑郁和认知症状严重的HIV感染且被诊断为LD的成年人患NCI的几率最高。这些发现有助于完善当前的HAND诊断指南。
