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 (HIV+) and negative participants were recruited to a cross-sectional study from two 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 (GDS), were used. Age- and education-adjusted NP test scores were directly compared with reference population data. RESULTS: 248 HIV+ and 45 HIV-negative MSM participated. In the HIV+ group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells/mm, and 88% were on antiretroviral therapy (ART). Prevalence of HAND was 21.0% in HIV+ MSM (13.7% asymptomatic neurocognitive impairment [ANI], 6.5% minor neurocognitive disorder [MND] and 0.8% HIV-associated dementia [HAD]). Using a GDS 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+ patients relative to male general population data (n=380). CONCLUSION: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV+ MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV+ MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
Publication statusAccepted/In press - Jul 2 2014

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HIV
Population
Cognitive Dysfunction
Neuropsychological Tests
Licensure
AIDS Dementia Complex
Normal Distribution
CD4 Lymphocyte Count
Activities of Daily Living
HIV Infections
Anxiety
Cross-Sectional Studies
Demography
Neurocognitive Disorders
Depression
Education

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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

In: Journal of Acquired Immune Deficiency Syndromes, 02.07.2014.

Research output: Contribution to journalArticle

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. https://doi.org/10.1097/QAI.0000000000000273
McDonnell, Jeffrey ; Haddow, Lewis ; Daskalopoulou, Marina ; Lampe, Fiona ; Speakman, Andrew ; Gilson, Richard ; Phillips, Andrew ; Sherr, Lorraine ; Wayal, Sonali ; Harrison, John ; Antinori, Andrea ; Maruff, Paul ; Schembri, Adrian ; Johnson, Margaret ; Collins, Simon ; Rodger, Alison. / 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. In: Journal of Acquired Immune Deficiency Syndromes. 2014.
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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 (HIV+) and negative participants were recruited to a cross-sectional study from two 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 (GDS), were used. Age- and education-adjusted NP test scores were directly compared with reference population data. RESULTS: 248 HIV+ and 45 HIV-negative MSM participated. In the HIV+ group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells/mm, and 88{\%} were on antiretroviral therapy (ART). Prevalence of HAND was 21.0{\%} in HIV+ MSM (13.7{\%} asymptomatic neurocognitive impairment [ANI], 6.5{\%} minor neurocognitive disorder [MND] and 0.8{\%} HIV-associated dementia [HAD]). Using a GDS 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+ patients relative to male general population data (n=380). CONCLUSION: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV+ MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV+ MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.",
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T2 - Effect of case definitions, and comparison with the general population and HIV negative men

AU - McDonnell, Jeffrey

AU - Haddow, Lewis

AU - Daskalopoulou, Marina

AU - Lampe, Fiona

AU - Speakman, Andrew

AU - Gilson, Richard

AU - Phillips, Andrew

AU - Sherr, Lorraine

AU - Wayal, Sonali

AU - Harrison, John

AU - Antinori, Andrea

AU - Maruff, Paul

AU - Schembri, Adrian

AU - Johnson, Margaret

AU - Collins, Simon

AU - Rodger, Alison

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N2 - 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 (HIV+) and negative participants were recruited to a cross-sectional study from two 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 (GDS), were used. Age- and education-adjusted NP test scores were directly compared with reference population data. RESULTS: 248 HIV+ and 45 HIV-negative MSM participated. In the HIV+ group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells/mm, and 88% were on antiretroviral therapy (ART). Prevalence of HAND was 21.0% in HIV+ MSM (13.7% asymptomatic neurocognitive impairment [ANI], 6.5% minor neurocognitive disorder [MND] and 0.8% HIV-associated dementia [HAD]). Using a GDS 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+ patients relative to male general population data (n=380). CONCLUSION: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV+ MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV+ MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

AB - 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 (HIV+) and negative participants were recruited to a cross-sectional study from two 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 (GDS), were used. Age- and education-adjusted NP test scores were directly compared with reference population data. RESULTS: 248 HIV+ and 45 HIV-negative MSM participated. In the HIV+ group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells/mm, and 88% were on antiretroviral therapy (ART). Prevalence of HAND was 21.0% in HIV+ MSM (13.7% asymptomatic neurocognitive impairment [ANI], 6.5% minor neurocognitive disorder [MND] and 0.8% HIV-associated dementia [HAD]). Using a GDS 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+ patients relative to male general population data (n=380). CONCLUSION: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV+ MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV+ MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

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