Key Learnings:
Firstly, we must remember to be aware of NCI, particularly in its early stages when it can be so very subtle. In the study NCI was observed in over a third of patients (37.2%). The median age of the cohort was 46.
The study looked at a number of factors independently associated with HAND and concluded that anxiety, abnormal International HIV Dementia Screen (IHDS), being black and African, below college level education, non-MSM transmission route and CPE (CNS penetration effectiveness) score >8 were associated with HAND.
As part of routine social history taking when assessing PLWH it is good clinical practice to screen for NCI. Asking simple questions which could allude to either the mental or physical manifestations such as impairment in memory, concentration or attention as well as reducing motor skills. To go one step further screening tools such as the Montreal Cognitive Assessment (MoCA) can be performed and should not take much more than 10 minutes. However, data has shown that such tools lack sensitivity and specificity, and as we know other chronic mental health conditions such as depression, anxiety or those impairing memory, Alzheimer’s and vascular dementia for example, can present in a similar fashion or concurrently. More comprehensive, sophisticated assessments such as the computerised Cogstate tests were used in this study.
Following on from this, we must consider whether our findings are in fact HIV-related or due to other chronic mental health conditions such as depression, anxiety, or other forms of dementia.
Author bio:
Charlie is an East London trained GP with a special interest in Sexual and Reproductive Health. She is currently working at Cairns North Sexual Health Clinic and as a GP as an HIV s100 prescriber.
