Addressing Cognitive Symptoms in People With HIV: Outcomes From a Holistic Screening and Management Pathway

Area of Science:

• Neuroscience
• Infectious Diseases
• Public Health

Background:

• Cognitive impairment is a significant concern for people living with HIV (PLWH).
• Early identification and management of cognitive symptoms are crucial for improving quality of life.
• Integrating cognitive screening into routine HIV care can enhance patient outcomes.

Purpose of the Study:

• To implement and evaluate a cognitive screening and management pathway for PLWH.
• To assess the feasibility and outcomes of this pathway within a UK HIV service.
• To identify effective interventions for managing cognitive impairment in PLWH.

Main Methods:

• Cognitive symptoms were screened using European AIDS Clinical Society questions during routine HIV appointments.
• Symptomatic individuals completed the Montreal Cognitive Assessment (MoCA).
• Scores below 26/30 on MoCA prompted referral to a dedicated HIV-Memory clinic for further assessment and intervention.

Main Results:

• Over 1500 individuals were screened, with 155 reporting symptoms.
• 33 individuals scored below 26 on the MoCA, indicating potential cognitive impairment.
• Interventions included lifestyle management, mental health support, HIV therapy adjustment, and cognitive remediation.
• Significant improvements were observed in global cognitive function and specific domains like delayed memory and executive function (P < 0.03).

Conclusions:

• The cognitive screening and management pathway is feasible for routine HIV care.
• Personalized interventions addressing holistic factors can stabilize or improve cognitive performance in PLWH.
• This pathway demonstrates the potential benefit of proactive cognitive care in managing HIV-associated neurocognitive disorders.