Defining cognitive impairment in people-living-with-HIV: the POPPY study

Davide De Francesco, Jonathan Underwood, Frank A Post, Jaime H Vera, Ian Williams, Marta Boffito, Memory Sachikonye, Jane Anderson, Patrick W G Mallon, Alan Winston, Caroline A Sabin, POPPY study group, Davide De Francesco, Jonathan Underwood, Frank A Post, Jaime H Vera, Ian Williams, Marta Boffito, Memory Sachikonye, Jane Anderson, Patrick W G Mallon, Alan Winston, Caroline A Sabin, POPPY study group

Abstract

Background: The reported prevalence of cognitive impairment (CI) varies widely in cohorts of people living with HIV (PLWH); this may partly be due to the use of different diagnostic criteria. Agreement between diagnostic criteria of CI, the optimal definition to use, and associations with patient-reported cognitive symptoms have not been fully investigated.

Methods: Two hundred ninety PLWH aged >50 years and 97 matched negative controls completed a detailed assessment of cognitive function and three questions regarding cognitive symptoms. Age- and education-adjusted test scores (T-scores) determined if subjects met the following definitions of CI: Frascati, global deficit score (GDS) and the multivariate normative comparison (MNC) method.

Results: PLWH were more likely than controls to meet each definition of CI (ORs were 2.17, 3.12 and 3.64 for Frascati, GDS and MNC, respectively). Agreement of MNC with Frascati and GDS was moderate (Cohen's k = 0.42 and 0.48, respectively), whereas that between Frascati and GDS was good (k = 0.74). A significant association was found between all the three criteria and reporting of memory loss but not with attention and reasoning problems. The 41 (14 %) PLWH meeting all the three criteria had the lowest median global T-score (36.9) and highest rate of symptom reporting (42 %).

Conclusions: Different CI criteria show fair diagnostic agreement, likely reflecting their ability to exclude CI in the same group of individuals. Given the lower overall cognitive performance and higher rates of symptom reporting in those meeting all three criteria of CI, further work assessing this as a definition of CI in PLWH is justified.

Keywords: Cognitive impairment; HIV; HIV-associated neurocognitive disorder; Neurology; Patient-reported cognitive symptoms.

Figures

Fig. 1
Fig. 1
Classification of CI among HIV-positive individuals according to the three criteria and agreement between criteria in HIV-positive and HIV-negative participants
Fig. 2
Fig. 2
Domain T-scores in HIV-positive individuals classified as cognitively impaired by the three criteria
Fig. 3
Fig. 3
Median global T-score (a) and proportion of subjects reporting two or more cognitive problems (b) by subset of HIV-positive participants meeting different combinations of the three definitions of CI

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