Date Published:
2013 Jan 01

Publication Type:
Journal Article

Authors:

M. Sakamoto
T.D. Marcotte
A. Umlauf
D. Franklin
R.K. Heaton
R.J. Ellis
S. Letendre
T. Alexander
J.A. McCutchan
E.E. Morgan
S.Paul Woods
A.C. Collier
C.M. Marra
D.B. Clifford
B. Gelman
J.C. McArthur
S. Morgello
D.M. Simpson
I. Grant

Secondary:
J Acquir Immune Defic Syndr

Volume:
62

Pagination:
36-42

Issue:
1

PMID:
23111573

URL:
https://pubmed.ncbi.nlm.nih.gov/23111573

DOI:
10.1097/QAI.0b013e318278ffa4

Keywords:
Adult;AIDS Dementia Complex;CHARTER;Clinical Medicine;Female;Humans;Internal;Male;Middle Aged;Sensitivity and Specificity;Severity of Illness Index;United States

Abstract:
<p>BACKGROUND: The HIV Dementia Scale (HDS) was developed to screen for HIV-associated neurocognitive disorders (HAND), but concerns have persisted regarding its substandard sensitivity. This study aimed to examine the classification accuracy of the HDS using raw and norm-based cut points and to evaluate the contribution of the HDS subtests to predicting HAND.METHODS: A total of 1580 HIV-infected participants from 6 US sites completed the HDS, and a gold standard neuropsychological battery, on which 51% of participants were impaired.RESULTS: Sensitivity and specificity to HAND using the standard raw HDS cut point were 24% and 92%, respectively. The raw HDS subtests of attention, recall, and psychomotor speed significantly contributed to classification of HAND, whereas visuomotor construction contributed the least. A modified raw cut point of 14 yielded sensitivity of 66% and specificity of 61%, with cross-validation. Using norms also significantly improved sensitivity to 69% with a concomitant reduction of specificity to 56%, whereas the positive predictive value declined from 75% to 62% and negative predictive value improved from 54% to 64%. The HDS showed similarly modest rates of sensitivity and specificity among subpopulations of individuals with minimal comorbidity and successful viral suppression.CONCLUSIONS: Findings indicate that while the HDS is a statistically significant predictor of HAND, particularly when adjusted for demographic factors, its relatively low diagnostic classification accuracy continues to hinder its clinical utility. A raw cut point of 14 greatly improved the sensitivity of the previously established raw cut score, but may be subject to ceiling effects, particularly on repeat assessments.</p>