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

Jeffrey McDonnell, Lewis Haddow, Marina Daskalopoulou, Fiona Lampe, Andrew Speakman, Richard Gilson, Andrew Phillips, Lorraine Sherr, Sonali Wayal, John Harrison, Andrea Antinori, Paul Maruff, Adrian Schembri, Margaret Johnson, Simon Collins, Alison Rodger

Research output: Contribution to journalArticle

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 computerassisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIVassociated 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% HIVassociated 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 HIVpositive 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.

Original languageEnglish
Pages (from-to)120-127
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume67
Issue number2
Publication statusPublished - 2014

Keywords

  • Cognition disorders
  • Cross-sectional studies
  • HIV infections
  • Men who have sex with men
  • Neuropsychological tests

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    McDonnell, J., Haddow, L., Daskalopoulou, M., Lampe, F., Speakman, A., Gilson, R., Phillips, A., Sherr, L., Wayal, S., Harrison, J., Antinori, A., Maruff, P., Schembri, A., Johnson, M., Collins, S., & Rodger, A. (2014). 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. Journal of Acquired Immune Deficiency Syndromes, 67(2), 120-127.