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AIDS:
doi: 10.1097/QAD.0b013e3283354a7b
Basic Science

Cognitive dysfunction in HIV patients despite long-standing suppression of viremia

Simioni, Samantaa; Cavassini, Matthiasc; Annoni, Jean-Mariea,e; Rimbault Abraham, Alinee; Bourquin, Isabellea; Schiffer, Véroniquef; Calmy, Alexandraf; Chave, Jean-Philipped; Giacobini, Eziog; Hirschel, Bernardf; Du Pasquier, Renaud Aa,b

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Abstract

Objective: To determine the prevalence of cognitive complaints and HIV-associated neurocognitive disorders (HANDs) in a cohort of aviremic HIV-positive patients. To evaluate the relevance of the HIV dementia scale to detect HANDs.

Design: Assessment of HANDs with neuropsychological tests.

Methods: Two hundred HIV-infected patients with undetectable HIV-1 RNA concentrations in the plasma, no history of major opportunistic infection of the central nervous system in the past 3 years, no current use of intravenous drugs, and no major depression answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of 50 complaining and 50 noncomplaining HIV-positive patients were assessed.

Results: Patients had undetectable HIV-1 RNA concentrations for a median time of 48 months (range 3.2–136.6). The prevalence of cognitive complaints was 27%. The prevalence of HANDs was 84% among patients with cognitive complaints (asymptomatic neurocognitive impairment 24%, mild neurocognitive disorders 52%, and HIV-associated dementia 8%) and 64% among noncomplainers (asymptomatic neurocognitive impairment 60%, mild neurocognitive disorders 4%, and HIV-associated dementia 0%; P < 0.001). A score of 14 points or less on the HIV dementia scale yielded a positive predictive value of HANDs of 92% in complainers and 82% in noncomplainers.

Conclusion: The prevalence of HANDs is high even in long-standing aviremic HIV-positive patients. However, HANDs without functional repercussion in daily life (asymptomatic neurocognitive impairment) is the most frequent subtype observed. In this population, the HIV dementia scale with a cutoff of 14 points or less seems to provide a useful tool to screen for the presence of HANDs.

© 2010 Lippincott Williams & Wilkins, Inc.

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