severity of neurocognitive impairment does not differ between HIV-positive and
HIV-negative gay men, UK investigators report in the online edition of the Journal of Acquired Immune Deficiency
Syndromes. The authors believe their findings have implications for the
ways in which cognitive disorders are diagnosed in people living with HIV in the
modern treatment era. “Only through correct classification can we maximise the
efficacy of recommended interventions in those with true HIV-related cognitive
impairment,” comment the authors.
effective antiretroviral treatment, HIV-associated dementia is now rare.
However, some research has suggested that as many as 50% of people living with HIV
have some form of neurocognitive impairment.
in the UK, however, has found relatively low rates of cognitive impairment; the
19% prevalence is similar to that seen in the general population.
To further clarify
this question, investigators from two London hospitals compared the prevalence
of neurocognitive impairment between HIV-positive and HIV-negative gay men.
Participants were recruited to the cross-sectional study in 2011-12 and cognitive
function was assessed using computer-assisted and pencil and paper tests. Accepted
definitions of HIV-associated neurocognitive disorders (HAND – asymptomatic,
mild, dementia) and global deficit scores (GDS) were used.
population comprised 248 HIV-positive and 45 HIV-negative men. The HIV-positive
participants were older than the HIV-negative group (mean age = 46 vs 33
years, p < 0.001). Both groups were predominately white (80%) and 60% had a
problematic alcohol use – known risk factors for neurocognitive impairment –
were highly prevalent in both groups. Rates of depression were higher among people living with HIV compared to the HIV-negative controls (29 vs 8%), but
prevalence of moderate-to-severe anxiety did not differ significantly between
the two groups (21 vs 14%).
of HAND was 21% among the people living with HIV. This included 13.7%
with asymptomatic impairment, 6.5% with mild impairment and 0.8% with
Applying the same
assessment criteria to the HIV-negative sample showed a neurocognitive disorder prevalence of 29%.
Most cases (24%) were asymptomatic and the other cases involved only mild impairment.
were little altered in sensitivity analyses that excluded people with severe
depressive symptoms or AIDS-defining neurocognitive disorders.
neurocognitive impairment between the two groups was also comparable when the
authors assessed GDS using five domains (HIV-positive = 32% vs HIV-negative =
27%) and ten domains (HIV-positive = 40% vs HIV-negative = 42%).
with HAND in the HIV-positive group included lower educational attainment (OR =
3.41 vs. university degree or higher degree, 95% CI, 1.73-6.70, p < 0.001)
and increasing age (OR = 1.05 per additional year; 95% CI, 1.01-1.08, p =
“Levels of NCI [neurocognitive impairment] in
HIV+ MSM [men who have sex with men] in the UK could have been overestimated,”
write the authors. “Diagnosed deficits may often not be related to HIV.”
propose that diagnostic criteria for HAND should be re-evaluated thus:
- Increase level of deficit
needed to meet criteria.
- Improve validity of assessments
of everyday function.
- Include biomarkers.
- Incorporate repeat assessments.
They also stress
the importance of addressing factors associated with the protection of
cognitive function in the general population: exercise, stopping smoking, diet,
treatment of diabetes and depression.