Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection

the AGEhIV Cohort Study Group

doi:https://doi.org/10.1097/QAD.0000000000000573

Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection

the AGEhIV Cohort Study Group

Research output: Contribution to journal › Article › Academic › peer-review

69 Citations (Scopus)

Abstract

Objective: The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gisslén criteria. Methods: One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gisslén criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group. Results: HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gisslén criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity. Conclusion: Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gisslén criteria, while the false positive rate was greatly reduced compared with the Frascati criteria.

Original language	English
Pages (from-to)	547-557
Number of pages	11
Journal	AIDS
Volume	29
Issue number	5
DOIs	https://doi.org/10.1097/QAD.0000000000000573
Publication status	Published - 13 Mar 2015

Keywords

HIV infection
HIV-associated neurocognitive disorders
ageing
cognitive disorders
neuropsychological assessment

Access to Document

https://doi.org/10.1097/QAD.0000000000000573

Cite this

@article{787dce59ade24f2caa99bac46697b409,

title = "Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection",

abstract = "Objective: The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gissl{\'e}n criteria. Methods: One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gissl{\'e}n criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group. Results: HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gissl{\'e}n criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity. Conclusion: Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gissl{\'e}n criteria, while the false positive rate was greatly reduced compared with the Frascati criteria.",

keywords = "HIV infection, HIV-associated neurocognitive disorders, ageing, cognitive disorders, neuropsychological assessment",

author = "{the AGEhIV Cohort Study Group} and Tanja Su and Judith Schouten and Geurtsen, {Gert J.} and Wit, {Ferdinand W.} and Stolte, {Ineke G.} and Maria Prins and Peter Portegies and Caan, {Matthan W.A.} and Peter Reiss and Majoie, {Charles B.} and Schmand, {Ben A.} and {Van Der Valk}, M. and Kooij, {K. W.} and {Van Zoest}, {R. A.} and Elsenga, {B. C.} and M. Martens and S. Moll and J. Berkel and L. M{\"o}ller and Visser, {G. R.} and C. Welling and S. Zaheri and Hillebregt, {M. M.J.} and Gras, {L. A.J.} and Ruijs, {Y. M.C.} and Benschop, {D. P.} and Kootstra, {N. A.} and Harskamp-Holwerda, {A. M.} and I. Maurer and {Mangas Ruiz}, {M. M.} and Girigorie, {A. F.} and {Van Leeuwen}, E. and Janssen, {F. R.} and M. Heidenrijk and Schrijver, {J. H.N.} and W. Zikkenheiner and M. Wezel and Jansen-Kok, {C. S.M.} and Geerlings, {S. E.} and Godfried, {M. H.} and A. Goorhuis and {Van Der Meer}, {J. T.M.} and Nellen, {F. J.B.} and {Van Der Poll}, T. and Wiersinga, {W. J.} and {Van Eden}, J. and P. Lips and {De Jong}, M. and Verbraak, {F. D.} and Ruh{\'e}, {H. G.}",

year = "2015",

month = mar,

day = "13",

doi = "https://doi.org/10.1097/QAD.0000000000000573",

language = "English",

volume = "29",

pages = "547--557",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

TY - JOUR

T1 - Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection

AU - the AGEhIV Cohort Study Group

AU - Su, Tanja

AU - Schouten, Judith

AU - Geurtsen, Gert J.

AU - Wit, Ferdinand W.

AU - Stolte, Ineke G.

AU - Prins, Maria

AU - Portegies, Peter

AU - Caan, Matthan W.A.

AU - Reiss, Peter

AU - Majoie, Charles B.

AU - Schmand, Ben A.

AU - Van Der Valk, M.

AU - Kooij, K. W.

AU - Van Zoest, R. A.

AU - Elsenga, B. C.

AU - Martens, M.

AU - Moll, S.

AU - Berkel, J.

AU - Möller, L.

AU - Visser, G. R.

AU - Welling, C.

AU - Zaheri, S.

AU - Hillebregt, M. M.J.

AU - Gras, L. A.J.

AU - Ruijs, Y. M.C.

AU - Benschop, D. P.

AU - Kootstra, N. A.

AU - Harskamp-Holwerda, A. M.

AU - Maurer, I.

AU - Mangas Ruiz, M. M.

AU - Girigorie, A. F.

AU - Van Leeuwen, E.

AU - Janssen, F. R.

AU - Heidenrijk, M.

AU - Schrijver, J. H.N.

AU - Zikkenheiner, W.

AU - Wezel, M.

AU - Jansen-Kok, C. S.M.

AU - Geerlings, S. E.

AU - Godfried, M. H.

AU - Goorhuis, A.

AU - Van Der Meer, J. T.M.

AU - Nellen, F. J.B.

AU - Van Der Poll, T.

AU - Wiersinga, W. J.

AU - Van Eden, J.

AU - Lips, P.

AU - De Jong, M.

AU - Verbraak, F. D.

AU - Ruhé, H. G.

PY - 2015/3/13

Y1 - 2015/3/13

N2 - Objective: The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gisslén criteria. Methods: One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gisslén criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group. Results: HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gisslén criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity. Conclusion: Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gisslén criteria, while the false positive rate was greatly reduced compared with the Frascati criteria.

AB - Objective: The objective of this study is to assess whether multivariate normative comparison (MNC) improves detection of HIV-1-associated neurocognitive disorder (HAND) as compared with Frascati and Gisslén criteria. Methods: One-hundred and three HIV-1-infected men with suppressed viremia on combination antiretroviral therapy (cART) for at least 12 months and 74 HIV-uninfected male controls (comparable regarding age, ethnicity, sexual orientation, premorbid intelligence and educational level), aged at least 45 years, underwent neuropsychological assessment covering six cognitive domains (fluency, attention, information processing speed, executive function, memory, and motor function). Frascati and Gisslén criteria were applied to detect HAND. Next, MNC was performed to compare the cognitive scores of each HIV-positive individual against the cognitive scores of the control group. Results: HIV-infected men showed significantly worse performance on the cognitive domains of attention, information processing speed and executive function compared with HIV-uninfected controls. HAND by Frascati criteria was highly prevalent in HIV-infected [48%; 95% confidence interval (95% CI) 38-58] but nearly equally so in HIV-uninfected men (36%; 95% CI 26-48), confirming the low specificity of this method. Applying Gisslén criteria, HAND-prevalence was reduced to 5% (95% CI 1-9) in HIV-infected men and to 1% (95% CI 1-3) among HIV-uninfected controls, indicating better specificity but reduced sensitivity. MNC identified cognitive impairment in 17% (95% CI 10-24) of HIV-infected men and in 5% (95% CI 0-10) of the control group (P = 0.02, one-tailed), showing an optimal balance between sensitivity and specificity. Conclusion: Prevalence of cognitive impairment in HIV-1-infected men with suppressed viremia on cART estimated by MNC was much higher than that estimated by Gisslén criteria, while the false positive rate was greatly reduced compared with the Frascati criteria.

KW - HIV infection

KW - HIV-associated neurocognitive disorders

KW - ageing

KW - cognitive disorders

KW - neuropsychological assessment

UR - http://www.scopus.com/inward/record.url?scp=84926526923&partnerID=8YFLogxK

U2 - https://doi.org/10.1097/QAD.0000000000000573

DO - https://doi.org/10.1097/QAD.0000000000000573

M3 - Article

C2 - 25587908

SN - 0269-9370

VL - 29

SP - 547

EP - 557

JO - AIDS

JF - AIDS

IS - 5

ER -

Multivariate normative comparison, a novel method for more reliably detecting cognitive impairment in HIV infection

Abstract

Keywords

Access to Document

Other files and links

Cite this