Screening for HIV-associated neurocognitive disorders in perinatally infected adolescents: Youth-International HIV dementia scale validation
Phillips, N.J Thomas, K.G.F Myer, L Sacktor, N Zar, H.J Stein, D.J Hoare, J
Phillips, N.J
Thomas, K.G.F
Myer, L
Sacktor, N
Zar, H.J
Stein, D.J
Hoare, J
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Abstract
Context: Perinatal HIV infection has adverse cognitive consequences into adolescence. However, there are no screening tools that assess risk for HIV-associated neurocognitive disorders in adolescent populations. Such screening tools are needed urgently for clinical care in resource-poor settings with a high prevalence of HIV.
Objective: To investigate the performance of the International HIV Dementia Scale (IHDS) as a screening tool for HIV-associated neurocognitive disorders in perinatally adolescents.
Design: The current study is a quantitative, quasiexperimental design.
Methods: Perinatally HIV-infected adolescents aged 9-12 years were recruited from community health clinics into the Cape Town Adolescent Antiretroviral Cohort; matched HIV-negative controls from the same communities were enrolled. Each participant completed the IHDS and a comprehensive neuropsychological battery. The adult version of the IHDS was performed, except for two minor modifications. We evaluated the diagnostic validity of this modified instrument, the youth-IHDS (y-IHDS), using a four-step process that included sensitivity and specificity calculations, and generating receiver operating characteristic curves. Validity was measured against the youth HIV-associated diagnostic criteria.
Results: At a cut-off score of 10 or less, the y-IHDS demonstrated good sensitivity (94%) but poor specificity (24%) for detecting all forms of neurocognitive disorders, with an acceptable area under the curve value of 0.695.
Conclusion: The y-IHDS requires minimal resources and is based on a screening tool for adult HIV-associated cognitive disorders that is already widely used globally. Hence, this brief, cost-efficient, and valid screening tool may be a useful addition for clinicians working in resource-poor contexts in which adolescent HIV is highly prevalent.
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2019-01-17
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Wolters Kluwer
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Phillips NJ, Thomas KGF, Myer L, Sacktor N, Zar HJ, Stein DJ, Hoare J. Screening for HIV-associated neurocognitive disorders in perinatally infected adolescents: youth-International HIV Dementia Scale validation. AIDS. 2019 Apr 1;33(5):815-824. doi: 10.1097/QAD.0000000000002144.