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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000273
Clinical Science

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

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Abstract

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.

© 2014 by Lippincott Williams & Wilkins

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