mental health AIDS

Winter 2006 Newsletter / Volume 7, Issue 2

HIV Assessment News

Neuropsychological Assessment

Richardson, Morgan, et al. (2005) evaluated the utility of the HIV Dementia Scale (HDS) as a screening tool for NP impairment with a sample of 40 adults living with HIV who also had histories of psychiatric and substance use disorders. This small sample was 65% male and 55% African American; the average age of participants was 41 years and the average educational level was 12.2 years. When the HDS was administered, "[40%] were identified as at high risk for significant cognitive-motor disorder (HDS total score < 10). After controlling for age, education, illness (absolute CD4), and depressed mood, [investigators found that] high-risk participants performed significantly worse on measures of simple and sustained divided attention, psychomotor speed, and working memory. However, only 25 of 40 (63%) were correctly classified based on their performance on traditional tests of [NP] functioning" (p. 1013). The investigators conclude that "the HDS may lack sufficient sensitivity as an independent screen for [NP] impairment, particularly among individuals that present with multiple and overlapping risk factors for significant cognitive-motor deficits. Intact performance (i.e., above established cut off levels) contributed to a significant number of false negative errors, suggesting that a more complete [NP] test battery should be administered in cases in which subtle neurocognitive deficits are suspected or where multilayer risk factors for such deficits are present" (p. 1019).

Beginning in 1996, Italian investigators (Tozzi et al., 2005) monitored 412 individuals living with HIV and receiving highly active antiretroviral therapy (HAART) over an 84-month period to assess the association between HIV-associated neurocognitive impairment and survival. Within this cohort, 54.4% were neurocognitively impaired and 45.6% were neurocognitively unimpaired. At the same time, durable virological suppression under HAART was achieved by 63.3% of those who were unimpaired and by 49.6% of those who were impaired. Over this 7-year period, 47 deaths were recorded, 38 among those who were impaired and 9 among those who were unimpaired.

In their analysis of these data, Tozzi and colleagues "found that [neurocognitive impairment] was independently associated with reduced survival only among the patients experiencing virological failure, while the survival probability of patients with a durable virological suppression was not affected by [neurocognitive impairment]. An additional finding ... was that patients with [neurocognitive impairment] had a poorer virological response to HAART when compared with subjects without [neurocognitive impairment]" (p. 710). According to the investigators, these findings "highlight the importance of fully suppressive antiretroviral therapy in patients with HIV-related [neurocognitive impairment]. Second, since virological failure is common in clinical practice, being reported in 30-70% of patients, the assessment of cognitive function should be used in routine practice not only for its potential to reveal HIV-related [central nervous system] damage, but also for its association with reduced survival in ... patients .. with persistent viremia despite HAART" (p. 712).

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