Takeaway
- European AIDS Clinical Society (EACS) screening questions for identifying neurocognitive impairment (NCI) in well-treated HIV lack adequate positive/negative predictive value for guiding treatment.
Why this matters
- Consider neurological examination, brain MRI, or cerebrospinal fluid examination in patients with apparent functional impairment.
- EACS screening criteria can be used to identify and drive depression management.
Key results
- Prevalence of cognitive complaints among 974 participants with complete EACS screening data was 25.1% (244).
- 51.3% (122/238) vs 36.7% (264/719) without (P<.001).
- EACS screening positive predictive value (PPV) and negative predictive value (NPV) were:
- NCI diagnosis vs none: 0.51 (PPV) and 0.63 (NPV).
- HIV-associated NCI vs none: 0.35 and 0.70.
- Symptomatic NCI vs asymptomatic: 0.29 and 0.90.
- Severe depression (Center for Epidemiologic Studies Depression Scale [CES-D] score ≥27) was significantly associated with "yes definitely" for all EACS answers (P<.001).
- Patients answering "yes, definitely" to ≥1 question had higher median (interquartile range) CES-D scores:
- 14 (7-24) vs
- 5 (4-6) with no complaints (P<.0001).
Study design
- Prospective analysis of PPVs and NPVs of EACS screening questions among adult patients with well-controlled HIV, age ≥45 years.
- Funding: Swiss National Science Foundation.
Limitations
- Nongeneralizable.
- Selection bias.
- Frascati criteria may affect NCI sensitivity/specificity.
References
References