Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy
Abstract
:1. Introduction
2. Results
2.1. Patients’ Characteristics
2.2. Neurocognitive Disorders
2.3. Factors Associated with HIV-Associated Neurocognitive Disorders (HAND)
3. Discussion
3.1. HAND Prevalence and Classification
3.2. Cortical Profile and Depression Grade
3.3. Risk Factors Associated with HAND
4. Experimental Section
4.1. Materials and Methods
Subjects
4.2. Standard Protocol Approvals, Registration and Patient Consents
4.3. Patient Recruitment
Procedures
4.4. Neuropsychological Examination
- Visuo-spatial ability and memory: Rey–Osterrieth Complex Figure Test (ROCF), Copy and Delayed Recall;
- Verbal memory: Short Story, Digit Span Forward;
- Verbal fluency: Fluency for Letter, Fluency for Category;
- Executive functions and attention: Trail Making Test A e B.
- The MMSE has been used as a screening test, to evaluate possible disorders of intellectual efficiency and the presence of intellectual deterioration. This test examines eight different cognitive areas: orientation to time, orientation to space, registration, attention and calculation, recall, language, repetition, complex commands.
- Zung Self-Rating Depression Scale is a brief self-administered questionnaire that has been used to probe the presence of depression in the enrolled patients.
4.5. HAND Nosology
4.6. Statistical Analysis
5. Conclusions
Author Contributions
Conflict of Interest
References
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Variable | Total (n = 206) | Patients with HAND (n = 97) | Patients without HAND (n = 109) | p Value |
---|---|---|---|---|
Male (%) | 175 (85) | 88 (90.7) | 87 (79.8) | 0.03 |
Age. years. Mean (±SD) | 40.2 (10.4) | 42.4 (10.2) | 38.2 (10.2) | 0.03 |
Median (IQR) | 39 (33–48) | 39 (33–47.5) | 39 (33–47.2) | |
Risk factors: | n.s. | |||
heterosexual intercourse (%) | 124 (60.2) | 64 (66.0) | 60 (55.0) | n.s. |
homo/bisexual intercourse (%) | 82 (39.8) | 33 (34.0) | 49 (45.0) | n.s. |
injection drug users (%) | 39 (18.9) | 21 (21.6) | 18 (16.5) | n.s. |
Co-infection | ||||
HBV (%) | 29 (14.1) | 21 (21.6) | 8 (7.3) | 0.03 |
HCV (%) | 17 (8.3) | 12 (12.4) | 5 (4.6) | 0.04 |
Psychiatric medications (%) | 21 (10.2) | 15 (15.5) | 6 (5.5) | 0.02 |
Alcoholic abuse (%) | 41 (19.9) | 23 (23.7) | 18 (16.5) | n.s. |
Education years Mean (±SD) | 11.1 (3.7) | 10 (3.2) | 12 (3.9) | 0.001 |
Median (IQR) | 11 (8–13) | 11 (8–13) | 11 (8–13) | |
CD4+ T-cell/µL Mean (±SD) | 370 (276) | 331 (274) | 405 (275) | 0.054 |
Median (IQR) | 321 (163–545) | 304 (151–537) | 301 (148–535) | |
HIVRNA copies/mL Mean (±SD) | 112,566 (289,971) | 130,212 (358,380) | 96,861 (211,916) | n.s. |
Median (IQR) | 15,095 (1377–90,668) | 12,255 (1044–82,485) | 11,080 (1042–78,135) | |
CDC class C (%) | 29 (14.1) | 21 (21.6) | 8 (7.3) | 0.003 |
MMSE low score (%) | 18 (8.7) | 14 (14.4) | 4 (3.7) | 0.006 |
Variable | HR | 95% CI | p Value |
---|---|---|---|
Gender: female vs. male | 0.38 | 0.15–0.95 | 0.04 |
Education years (×1 year increase) | 0.85 | 0.78–0.93 | 0.001 |
HBV Co-infection (yes vs. no) | 2.94 | 1.13–7.63 | 0.026 |
HCV co-infection (yes vs. no) | 2.80 | 0.84–9.36 | 0.093 |
CDC class 3 (yes vs. no) | 3.36 | 1.35–8.35 | 0.009 |
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Focà, E.; Magro, P.; Motta, D.; Compostella, S.; Casari, S.; Bonito, A.; Brianese, N.; Ferraresi, A.; Rodari, P.; Pezzoli, M.C.; et al. Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy. Int. J. Mol. Sci. 2016, 17, 434. https://doi.org/10.3390/ijms17040434
Focà E, Magro P, Motta D, Compostella S, Casari S, Bonito A, Brianese N, Ferraresi A, Rodari P, Pezzoli MC, et al. Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy. International Journal of Molecular Sciences. 2016; 17(4):434. https://doi.org/10.3390/ijms17040434
Chicago/Turabian StyleFocà, Emanuele, Paola Magro, Davide Motta, Silvia Compostella, Salvatore Casari, Andrea Bonito, Nigritella Brianese, Alice Ferraresi, Paola Rodari, Maria Chiara Pezzoli, and et al. 2016. "Screening for Neurocognitive Impairment in HIV-Infected Individuals at First Contact after HIV Diagnosis: The Experience of a Large Clinical Center in Northern Italy" International Journal of Molecular Sciences 17, no. 4: 434. https://doi.org/10.3390/ijms17040434