51% of Irish patients with HIV show cognitive impairment
More than half of patients with HIV who participated in a cross sectional study screened positive for cognitive impairment, researchers in Ireland reported.
The researchers wrote that the results indicated “the necessity for a structured prospective large scale screening program for cognitive impairment across countries with limited resources for detailed neuropsychological analysis.
“Prevalence rates of 20% to 50% of HAND have been demonstrated in large prospective studies in the United States, Europe and Australia,” Patricia H. McNamara, of the department of neurology at St. James’s Hospital, Dublin, and colleagues wrote. “While these studies mainly conducted in western industrialized nations can give us reliable data due to the comprehensive nature of evaluations, there is a need to develop screening tools that can be used during routine care as comprehensive neuropsychological testing is beyond the resources of most HIV clinics, especially in the developing world.”
Researchers recruited patients with HIV who were treated at HIV clinics at St. James’s Hospital between December 2010 and February 2013 (n = 604). Just over half (51.5%) screened positive for cognitive impairment. Most patients were men (78.8%) and Irish (70.9%). Additionally, 49.3% were MSM. Mean patient age was 40.9 years. Eighty-three percent of patients were undergoing ART, and 88.7% had achieved viral suppression.
Logistic regression showed that being born in Africa (P < .000001), endorsement of cognitive symptoms (P = .024), use of benzodiazepines (P = .00341), unemployment (P = .008) and consumption of more than 40 units of alcohol per week (P = .035) were all predictive of a positive cognitive impairment screen, the researchers wrote. Approximately one quarter of patients tested positive for anxiety (24.5%), while 9.1% had depression.
McNamara and colleagues wrote that in addition to showing the need for national HAND screening programs, the study showed the feasibility and ease of implementation for such programs.
“It would add approximately 15 to 20 minutes to one annual visit and ensure that patients are being screened for the potential cognitive complications of HIV,” the researchers wrote. – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.