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Clinical Summary

EACS screening for HIV-associated neurocognitive impairment is inadequate

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


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