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Operationalizing and evaluating the Frascati criteria for functional decline in diagnosing HIV-associated neurocognitive disorders in adults

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Abstract

The Frascati criteria for HIV-associated neurocognitive disorders (HAND; Antinori et al. 2007) outlines a classification scheme for functional decline that—despite being over a decade old—has not heretofore been examined systematically. Participants included 307 HIV+ and 183 HIV− participants who completed self-report, clinician-rated, and performance-based measures of functional status, along with neurocognitive, psychiatric, and medical/laboratory assessments. Using the Frascati criteria, we classified participants with (1) no functional declines, (2) mild functional declines, or (3) major functional declines. A multivariable logistic regression showed that HIV serostatus was associated with higher rates of major (33.2 vs. 13.7%) but not mild (38.8 vs. 31.7%) Frascati-defined functional decline. Within the HIV+ group, individuals with global neurocognitive impairment and affective disorders were at highest risk of Frascati-defined functional decline. Findings provide some empirical support for the sensitivity and validity of the Frascati criteria for functional declines in the context of HAND. Future work is needed to determine the reliability, stability, cross-cultural validity, and downstream health-related consequences of the Frascati-defined functional classifications.

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Acknowledgments

This work was supported by the National Institutes of Health under Grants R01-MH073419, P30-MH62512, and R21-MH098607. The authors are grateful to the UC San Diego HIV Neurobehavioral Research Program (HNRP) Group (I. Grant, PI) for their infrastructure support of the parent R01. In particular, we thank Donald Franklin, Dr. Erin Morgan, Clint Cushman, and Stephanie Corkran for their assistance with data processing, Marizela Verduzco for her assistance with study management, Drs. Scott Letendre and Ronald J. Ellis for their assistance with the neuromedical aspects of the parent project, and Dr. J. Hampton Atkinson and Jennifer Marquie Beck and their assistance with participant recruitment and retention. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government. The authors thank the study volunteers for their participation.

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  1. Department of Psychology, University of Houston, 126 Heyne (ste 239d), Houston, TX, USA

    Anastasia Matchanova, Steven Paul Woods & Victoria M. Kordovski

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  1. Anastasia Matchanova
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  2. Steven Paul Woods
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Correspondence to Steven Paul Woods.

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Matchanova, A., Woods, S.P. & Kordovski, V.M. Operationalizing and evaluating the Frascati criteria for functional decline in diagnosing HIV-associated neurocognitive disorders in adults. J. Neurovirol. 26, 155–167 (2020). https://doi.org/10.1007/s13365-019-00809-z

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