Journal of NeuroVirology

, Volume 19, Issue 2, pp 137-143

First online:

Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND

  • Thep ChalermchaiAffiliated withSEARCH, The Thai Red Cross AIDS Research Center
  • , Victor ValcourAffiliated withMemory and Aging Center, Department of Neurology, University of California San FranciscoDivision of Geriatric Medicine, Department of Medicine, University of California San Francisco Email author 
  • , Pasiri SithinamsuwanAffiliated withPhramongkutklao Hospital
  • , Suteeraporn PinyakornAffiliated withHIV-NAT, The Thai Red Cross AIDS Research Center
  • , David CliffordAffiliated withDepartment of Neurology, Washington University in St Louis
  • , Robert H. PaulAffiliated withDepartment of Psychology, University of Missouri
  • , Somporn TipsukAffiliated withSEARCH, The Thai Red Cross AIDS Research Center
  • , James L. K. FletcherAffiliated withSEARCH, The Thai Red Cross AIDS Research Center
  • , Victor DeGruttolaAffiliated withDepartment of Biostatistics, Harvard School of Public Health
    • , Silvia Ratto-KimAffiliated withMilitary HIV Research Program, Walter Reed Army Institute of Research
    • , Nicholas HutchingsAffiliated withMemory and Aging Center, Department of Neurology, University of California San Francisco
    • , Cecilia ShikumaAffiliated withHawaii Center for AIDS, University of Hawaii at Mānoa
    • , Jintanat AnanworanichAffiliated withSEARCH, The Thai Red Cross AIDS Research CenterHIV-NAT, The Thai Red Cross AIDS Research CenterFaculty of Medicine, Chulalongkorn University
    • , The SEARCH 007 and 011 study groups

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Although HIV-associated dementia (HAD) occurs in less than 5 % of individuals with access to combination antiretroviral therapy, rates of milder forms of HIV-associated neurocognitive disorder (HAND) are much higher. We sought to define an optimal cut point for the International HIV Dementia Scale (IHDS) in Thailand for the identification of symptomatic HAND, defined as both HAD and mild neurocognitive disorder. We then sought to determine if adding a simple test from a larger neuropsychological battery could improve the performance characteristics for identifying symptomatic HAND. In this study, subjects comprising 75 seropositive adults in Bangkok, Thailand, completed neuropsychological tests and underwent a full neurological assessment. HAND diagnoses were determined by consensus conference using the 2007 Frascati criteria, blinded to the IHDS results. The optimal IHDS cut point was determined by receiver operating characteristic analysis with cross-validation. Individual neuropsychological tests were then evaluated and combined with the IHDS to test performance characteristics. The IHDS was poor at detecting symptomatic HAND at the optimized cut point of ≤10 (sensitivity, 53.3 %; specificity, 89.8 %). Trail Making Test A was most effective in improving performance characteristics when combined with the IHDS, with net sensitivity of 86 % and specificity of 79 %. In this setting, the IHDS performed poorly in identifying symptomatic HAND, but was substantially improved by the addition of Trail Making Test A, which typically requires less than 2 min to complete. This combination should be validated in a larger setting since it may address the critical need for HAND screening instruments in international settings.


HIV dementia Neuropsychology Asia Neuropsychological tests Trail Making Test