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Machine learning models reveal neurocognitive impairment type and prevalence are associated with distinct variables in HIV/AIDS

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Abstract

Neurocognitive impairment (NCI) among HIV-infected patients is heterogeneous in its reported presentations and frequencies. To determine the prevalence of NCI and its associated subtypes as well as predictive variables, we investigated patients with HIV/AIDS receiving universal health care. Recruited adult HIV-infected subjects underwent a neuropsychological (NP) test battery with established normative (sex-, age-, and education-matched) values together with assessment of their demographic and clinical variables. Three patient groups were identified including neurocognitively normal (NN, n = 246), HIV-associated neurocognitive disorders (HAND, n = 78), and neurocognitively impaired-other disorders (NCI-OD, n = 46). Univariate, multiple logistic regression and machine learning analyses were applied. Univariate analyses showed variables differed significantly between groups including birth continent, quality of life, substance use, and PHQ-9. Multiple logistic regression models revealed groups again differed significantly for substance use, PHQ-9 score, VACS index, and head injury. Random forest (RF) models disclosed that classification algorithms distinguished HAND from NN and NCI-OD from NN with area under the curve (AUC) values of 0.87 and 0.77, respectively. Relative importance plots derived from the RF model exhibited distinct variable rankings that were predictive of NCI status for both NN versus HAND and NN versus NCI-OD comparisons. Thus, NCI was frequently detected (33.5%) although HAND prevalence (21%) was lower than in several earlier reports underscoring the potential contribution of other factors to NCI. Machine learning models uncovered variables related to individual NCI types that were not identified by univariate or multiple logistic regression analyses, highlighting the value of other approaches to understanding NCI in HIV/AIDS.

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Data availability

All data presented within the present manuscript are available with accompanying accession numbers upon request to qualified investigators for secondary analyses.

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Acknowledgments

A Canadian Institutes of Health Research, Emerging Team Grant (EF, MJG, and CP) supported these studies. The authors thank the patients and staff at the Southern Alberta Clinic for their willingness to participate in the study and Brenda Beckthold for the technical assistance.

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Authors and Affiliations

  1. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada

    Wei Tu & Linglong Kong

  2. Department of Medicine (Neurology), University of Alberta, 6-11 Heritage Medical Research Centre, Edmonton, AB, Canada

    Patricia A. Chen & Christopher Power

  3. Department of Medicine, University of Calgary, Calgary, AB, Canada

    Noshin Koenig & M. John Gill

  4. Department of Psychiatry, University of Alberta, Edmonton, AB, Canada

    Daniela Gomez, Esther Fujiwara & Christopher Power

Authors
  1. Wei Tu
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  2. Patricia A. Chen
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  3. Noshin Koenig
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  4. Daniela Gomez
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  5. Esther Fujiwara
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  6. M. John Gill
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  7. Linglong Kong
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  8. Christopher Power
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Corresponding authors

Correspondence to Linglong Kong or Christopher Power.

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The University of Calgary Ethics Committee (REB #-130615) approved the study and written consent was obtained from all patients.

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The authors declare that they have no conflict of interest.

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Tu, W., Chen, P.A., Koenig, N. et al. Machine learning models reveal neurocognitive impairment type and prevalence are associated with distinct variables in HIV/AIDS. J. Neurovirol. 26, 41–51 (2020). https://doi.org/10.1007/s13365-019-00791-6

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  • DOI: https://doi.org/10.1007/s13365-019-00791-6

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