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Routine detection and management of neurocognitive impairment in HIV-positive patients in a UK centre
L J Haddow1, A Accoroni, J D Cartledge
1Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London.
Insights
This study found low prevalence of diagnosed HIV-associated dementia (HAD) but noted many patients with neurocognitive impairment (NCI) symptoms were misdiagnosed. Current screening may miss mild or asymptomatic HAND cases in UK clinics.
Area of Science:
- Neuroscience
- Infectious Diseases
- Public Health
Background:
- HIV-associated neurocognitive disorders (HAND) represent a significant challenge in clinical practice.
- Accurate estimation of HAND prevalence and incidence is crucial for effective patient management.
- Existing diagnostic methods may not capture the full spectrum of HAND, including milder forms.
Purpose of the Study:
- To estimate the prevalence and incidence of HIV-associated dementia (HAD) and neurocognitive impairment (NCI) in a UK clinic.
- To identify potential underdiagnosis of HAND, particularly milder or asymptomatic cases.
- To inform the need for evidence-based screening protocols in HIV clinics.
Main Methods:
- Retrospective analysis of a random sample of HIV patients and specialist service referrals over one year.
- Assessment for diagnosed HAD and reported symptoms suggestive of NCI.
- Calculation of prevalence and incidence rates with confidence intervals.
Main Results:
- Prevalence of documented HAD was 1.3% in a random sample (2/150).
- 7.3% reported NCI symptoms, often misdiagnosed as psychiatric or substance-use disorders.
- Annual incidence of HAD among specialist referrals was 0.4% (11/3129).
- No asymptomatic or mildly symptomatic HAND cases were identified, suggesting underdetection.
Conclusions:
- The study highlights a potential gap in identifying and diagnosing HAND, especially milder forms, in routine UK clinical practice.
- Current diagnostic approaches may lead to misdiagnosis of NCI symptoms in people living with HIV.
- Implementation of evidence-based screening for HAND in HIV clinics is recommended to improve detection rates.
Abstract:
We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2-4.7%) had documented HAD. Eleven patients (7.3%; CI 3.7-12.7%) reported recent symptoms suggesting NCI; most of these individuals were diagnosed with a psychiatric or substance-use disorder. Among specialist referrals with symptoms suggesting NCI, 11 were diagnosed with HAD from a clinic population of 3129 individuals (annual incidence 0.4%; CI 0.2-0.6%). No patients with mildly symptomatic or asymptomatic HAND were identified in either sample, suggesting that such patients remain undetected in current clinical practice. Evidence-based screening for HAND in HIV clinics may be needed.
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