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Screening for HIV-associated neurocognitive disorders in perinatally infected adolescents

youth-International HIV Dementia Scale validation

Phillips, Nicole J.a; Thomas, Kevin G.F.b; Myer, Landonc; Sacktor, Nedd; Zar, Heather J.e,f; Stein, Dan J.a,g; Hoare, Jacquelinea

doi: 10.1097/QAD.0000000000002144

Context: Perinatal HIV infection has adverse cognitive consequences into adolescence. However, there are no screening tools that assess risk for HIV-associated neurocognitive disorders in adolescent populations. Such screening tools are needed urgently for clinical care in resource-poor settings with a high prevalence of HIV.

Objective: To investigate the performance of the International HIV Dementia Scale (IHDS) as a screening tool for HIV-associated neurocognitive disorders in perinatally adolescents.

Design: The current study is a quantitative, quasiexperimental design.

Methods: Perinatally HIV-infected adolescents aged 9–12 years were recruited from community health clinics into the Cape Town Adolescent Antiretroviral Cohort; matched HIV-negative controls from the same communities were enrolled. Each participant completed the IHDS and a comprehensive neuropsychological battery. The adult version of the IHDS was performed, except for two minor modifications. We evaluated the diagnostic validity of this modified instrument, the youth-IHDS (y-IHDS), using a four-step process that included sensitivity and specificity calculations, and generating receiver operating characteristic curves. Validity was measured against the youth HIV-associated diagnostic criteria.

Results: At a cut-off score of 10 or less, the y-IHDS demonstrated good sensitivity (94%) but poor specificity (24%) for detecting all forms of neurocognitive disorders, with an acceptable area under the curve value of 0.695.

Conclusion: The y-IHDS requires minimal resources and is based on a screening tool for adult HIV-associated cognitive disorders that is already widely used globally. Hence, this brief, cost-efficient, and valid screening tool may be a useful addition for clinicians working in resource-poor contexts in which adolescent HIV is highly prevalent.

aDepartment of Psychiatry and Mental Health

bDepartment of Psychology, ACSENT Laboratory

cDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine

dDepartment of Child Health

eDepartment of Paediatrics and Child Health, University of Cape Town

fSAMRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town

gRisk and Resilience in Mental Disorders Research Unit, South African Medical Research Council, Pretoria, South Africa.

Correspondence to Nicole J. Phillips, MSocSci, Department of Psychiatry and Mental Health, University of Cape Town, Room 1, K-floor, AOPD, Groote Schuur Hospital, Groote Schuur Drive, Observatory, Cape Town 7925, South Africa. Tel: +27 21 404 7626; e-mail:

Received 31 August, 2018

Revised 9 January, 2019

Accepted 9 January, 2019

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