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Prospective Evaluation of an Abbreviated Test Battery to Screen for Neurocognitive Impairment in HIV-Positive Military Members

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Abstract

Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects around 20–50% of people living with HIV (PLWH). Although batteries of tests are used to identify neurocognitive impairment (NCI), they are long and difficult to perform during a routine clinic visit, thus impairing the ability to diagnose HAND. Therefore, a brief yet sensitive screening tool to identify NCI is necessary. This study prospectively evaluated an abbreviated screening battery with reported 86.5%/87.1% sensitivity/specificity, identified from a planned post-hoc analysis in a prior neurocognitive study among military PLWH. Adult HIV-positive military beneficiaries in the U.S. Military HIV Natural History Study, who agreed to undergo a comprehensive seven-domain neuropsychological battery (16 tests), and who completed an additional 20-min abbreviated battery (AB), comprised of four tests, prior to the full battery (FB) were included in this analysis. A group of 169 individuals completed both tests, of which 25.4% had a positive AB and 17.8% had NCI on FB (global deficit score ≥ 0.5). With the FB as the reference standard, the specificity for the AB was 79.9% (73.2–86.5), however the sensitivity was 50.0% (32.1–67.9). In those with NCI by FB but not AB, the most common impaired domains were executive function (73.3%) and memory (73.3%), both being domains not fully tested by the AB. An abbreviated HAND screening battery of four tests requiring approximately 20 min provided a relatively high level of specificity but lacked sensitivity for detection of NCI. Inclusion of additional domains or alternative scoring approaches may improve sensitivity but require further study. Continued efforts are needed to develop an effective brief screening test for HAND.

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Data Availability

Data for this study are available from the Infectious Disease Clinical Research Program (IDCRP), headquartered at the Uniformed Services University of the Health Sciences (USU), Department of Preventive Medicine and Biostatistics. The Informed Consent Document under which the HIV Natural History Study data were collected specifies that each use of the data will be reviewed by the Institutional Review Board. Furthermore, the data set may include Military Health System data collected under a Data Assurance Agreement that requires accounting for uses of the data. Data requests may be sent to: Address: 6270A Rockledge Drive, Suite 250, Bethesda, MD 20,817. Email: contactus@idcrp.org.

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Acknowledgements

The views expressed are those of the authors and do not necessarily reflect the official views of the Uniformed Services University of the Health Sciences, the National Institutes of Health, the Department of Health and Human Services, the Department of Defense, the Departments of the Army, Navy or Air Force, or the Henry M. Jackson Foundation for the Advancement of Military Medicine. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

Funding

This study was conducted by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense (DoD) program executed by the Uniformed Services University of the Health Sciences (USUHS) through a cooperative agreement with The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF). This project has been supported in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter‐Agency Agreement Y1-AI-5072 and from the Defense Health Program, U.S. Department of Defense, under Award HU0001190002.

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Authors and Affiliations

  1. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Brian K. Agan, Seung Hyun Won, Anuradha Ganesan, Camille Estupigan, Ryan Maves, Gregory Utz & Hsing-Chuan Hsieh

  2. Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA

    Brian K. Agan, Seung Hyun Won, Anuradha Ganesan, Camille Estupigan, Gregory Utz & Hsing-Chuan Hsieh

  3. Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Anuradha Ganesan

  4. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

    Bryan R. Smith & Avindra Nath

  5. Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA, USA

    Ryan Maves & Gregory Utz

  6. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA

    Edmund Tramont

  7. National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

    Joseph Snow

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  1. Brian K. Agan
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Contributions

BKA, AG, RM, GU, ET, AN, JS, and BRS conceived/designed the work. BKA, AG, RM, GU, BRS, and JS acquired data. SW and HH analyzed data. BKA, CE, HH, JS, BRS, and AN interpreted data. BKA and CE drafted the work. All authors revised the manuscript critically for important intellectual content and approved the final version to be published.

Corresponding author

Correspondence to Brian K. Agan.

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Conflict of Interest

The authors declare no competing interests or financial interest in this work.

Ethical Approval

This study was approved centrally by the Uniformed Services University of the Health Sciences’ institutional review board and by the participating sites (Walter Reed National Military Medical Center and Naval Medical Center San Diego).

Consent to Participate

All participants provided written informed consent.

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Agan, B.K., Won, S.H., Ganesan, A. et al. Prospective Evaluation of an Abbreviated Test Battery to Screen for Neurocognitive Impairment in HIV-Positive Military Members. AIDS Behav 25, 3347–3354 (2021). https://doi.org/10.1007/s10461-021-03341-6

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