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Cross-sectional analysis of cognitive function using multivariate normative comparisons in men with HIV disease

Wang, Zhenga; Molsberry, Samantha A.c; Cheng, Yua,b; Kingsley, Lawrenced,e; Levine, Andrew J.f; Martin, Eileeng; Munro, Cynthia A.h,i; Ragin, Annj; Rubin, Leah H.i,k; Sacktor, Nedi; Seaberg, Eric C.k; Becker, James T.l,m,n for the Neuropsychology Working Group of the Multicenter AIDS Cohort Study

doi: 10.1097/QAD.0000000000002312

Background: Prevalence estimates of cognitive impairment in HIV disease vary widely. Here we used multivariate normative comparison (MNC) with identify individuals with impaired cognition, and to compare the results with those using the Frascati and Gisslén criteria.

Methods: The current project used data collected before October 2014 from bisexual/gay men from the Multicenter AIDS Cohort Study. A total of 2904 men (mean age 39.7 years, 52.7% seropositive) had complete data in six cognitive domains at their first neuropsychological evaluation. T-scores were computed for each domain and the MNC was applied to detect impairment among seronegative and seropositive groups.

Results: The MNC classified 6.26% of seronegative men as being impaired using a predetermined 5% false discovery rate. By contrast, the Frascati and the Gisslén criteria identified 24.54 and 11.36% of seronegative men as impaired. For seropositive men, the percentage impairment was 7.45, 25.73, and 11.69%, respectively, by the MNC, Frascati and Gisslén criteria. When we used seronegative men without medical comorbidities as the control group, the MNC, the Frascati and the Gisslén criteria identified 5.05, 27.07, and 4.21% of the seronegative men, and 4.34, 30.95, and 4.48% of the seropositive men as having cognitive impairment. For each method, serostatus was not associated with cognitive impairment.

Conclusion: The MNC controls the false discovery rate and therefore avoids the low specificity that characterizes the Frascati and Gisslén criteria. More research is needed to evaluate the sensitivity of the MNC method in a seropositive population that may be sicker and older than the current study sample and that includes women.

aDepartment of Statistics

bDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania

cPopulation Health Sciences, Harvard University, Cambridge, Massachusetts

dDepartment of Epidemiology

eDepartment of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

fDepartment of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California

gDepartment of Psychiatry, Rush University School of Medicine, Chicago, Illinois

hDepartment of Psychiatry

iDepartment of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland

jDepartment of Radiology, Northwestern University, Evanston, Illinois

kDepartment of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland

lDepartment of Psychiatry

mDepartment of Neurology

nDepartment of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Correspondence to James T. Becker, PhD, Department of Psychiatry; Department of Neurology; Department of Psychology, University of Pittsburgh, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213, USA. Tel: +1 412 246 6970; e-mail:

Received 30 October, 2018

Revised 26 April, 2019

Accepted 3 June, 2019

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