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Minimal Cognitive Impairment in UK HIV-Positive Men Who Have Sex With Men: Effect of Case Definitions and Comparison With the General Population and HIV-Negative Men

McDonnell, Jeffrey MSc*; Haddow, Lewis PhD, MBChB*; Daskalopoulou, Marina MSc*; Lampe, Fiona PhD*; Speakman, Andrew PhD*; Gilson, Richard MD, MBBS*; Phillips, Andrew PhD*; Sherr, Lorraine PhD*; Wayal, Sonali PhD*; Harrison, John PhD; Antinori, Andrea MD; Maruff, Paul PhD§; Schembri, Adrian PhD§; Johnson, Margaret MD, MBBS; Collins, Simon MSc; Rodger, Alison MD, MBChB*for the Cognitive Impairment in People with HIV in the European Region (CIPHER) Study Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2014 - Volume 67 - Issue 2 - p 120–127
doi: 10.1097/QAI.0000000000000273
Clinical Science

Background: To determine the prevalence of neurocognitive impairment (NCI) in UK HIV-positive and HIV-negative men who have sex with men (MSM).

Methods: HIV-positive and HIV-negative participants were recruited to a cross-sectional study from 2 London clinics and completed computer-assisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIV-associated neurocognitive disorders (HAND) and global deficit scores were used. Age- and education-adjusted neuropsychological test scores were directly compared with reference population data.

Results: A total of 248 HIV-positive and 45 HIV-negative MSM participated. In the HIV-positive group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells per cubic millimeter, and 88% were on antiretroviral therapy. Prevalence of HAND was 21.0% in HIV-positive MSM (13.7% asymptomatic neurocognitive impairment, 6.5% mild neurocognitive disorder, and 0.8% HIV-associated dementia). Using a global deficit score threshold of 0.5, the prevalence of NCI was 31.5% (when averaged over 5 neuropsychological domains) and 40.3% (over 10 neuropsychological test scores). These results were not significantly different from the HIV-negative study sample. No consistent pattern of impairment was seen in HIV-positive patients relative to general male population data (n = 380).

Conclusions: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV-positive MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV-positive MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.

*Research Department of Infection and Population Health, University College London, London, United Kingdom;

Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom;

National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy;

§CogState, Melbourne, Victoria, Australia;

Department of Sexual Health and HIV, Royal Free London NHS Foundation Trust, London, United Kingdom; and

HIV I-Base, London, United Kingdom.

Correspondence to: Alison Rodger, MD, MBChB, Research Department of Infection and Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom (e-mail:

Supported by the European AIDS Treatment Network and the National Institute for Health Research (NIHR) under its Program Grants for Applied Research funding scheme (RP-PG-0608-10142).

All authors contributed to the conception, conduct and analysis of the study, and have reviewed the final manuscript. S.W., J.M, and colleagues conducted neuropsychological assessments. Data were analyzed by L.H., J.M., M.D., F.L., and AR. The final manuscript was written by L.H., J.M., M.D., F.L., P.M., R.G., L.S., and A.R.

P.M. is one of the founders of CogState and employed by the company as Chief Scientific Officer. A.S. is Director of Science at CogState. The remaining authors have no conflicts of interest to disclose.

Presented at the 20th Conference on Retroviruses and Opportunistic Infections, March 3–6, 2013, Atlanta, CA.

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Received February 25, 2014

Accepted May 23, 2014

© 2014 by Lippincott Williams & Wilkins