Journal of NeuroVirology

, Volume 19, Issue 2, pp 137–143 | Cite as

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

  • Thep Chalermchai
  • Victor Valcour
  • Pasiri Sithinamsuwan
  • Suteeraporn Pinyakorn
  • David Clifford
  • Robert H. Paul
  • Somporn Tipsuk
  • James L. K. Fletcher
  • Victor DeGruttola
  • Silvia Ratto-Kim
  • Nicholas Hutchings
  • Cecilia Shikuma
  • Jintanat Ananworanich
  • The SEARCH 007 and 011 study groups


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 



This work was supported by NIH grants R01-NS053359 (SR) and R01-NS061696 (VV). We thank the study subjects for their participation and Nicholas Hutchings for assistance with the manuscript.

SEARCH 007 and 011 protocol teams: Nittaya Phanuphak MD, Nitiya Chomchey, Somprartthana Rattanamanee, and Pairoa Praihirunkit from SEARCH/TRCARC; Nijasri Charnnarong MD and Sukalaya Lerdlum MD from Chulalongkorn University; Yotin Chinvarun MD from Phramongkutklao Medical Center; Mark de Souza PhD MPH, Alexandra Schuetz PhD, and Rapee Trichavaroj from the Armed Forces Research Institute of Medical Sciences; Supunee Jirajariyavej MD from Taksin Hospital; Bruce Shiramizu MD from the University of Hawai’i; and Carol Liu, Elijah Mun, Stephanie Chiao, and Lauren Wendelken from UCSF.

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Journal of NeuroVirology, Inc. 2013

Authors and Affiliations

  • Thep Chalermchai
    • 1
  • Victor Valcour
    • 2
    • 3
  • Pasiri Sithinamsuwan
    • 4
  • Suteeraporn Pinyakorn
    • 5
  • David Clifford
    • 6
  • Robert H. Paul
    • 7
  • Somporn Tipsuk
    • 1
  • James L. K. Fletcher
    • 1
  • Victor DeGruttola
    • 8
  • Silvia Ratto-Kim
    • 10
  • Nicholas Hutchings
    • 2
  • Cecilia Shikuma
    • 11
  • Jintanat Ananworanich
    • 1
    • 5
    • 9
  • The SEARCH 007 and 011 study groups
  1. 1.SEARCH, The Thai Red Cross AIDS Research CenterBangkokThailand
  2. 2.Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Division of Geriatric Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Phramongkutklao HospitalBangkokThailand
  5. 5.HIV-NAT, The Thai Red Cross AIDS Research CenterBangkokThailand
  6. 6.Department of NeurologyWashington University in St LouisSt LouisUSA
  7. 7.Department of PsychologyUniversity of MissouriSt. LouisUSA
  8. 8.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  9. 9.Faculty of MedicineChulalongkorn UniversityBangkokThailand
  10. 10.Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringUSA
  11. 11.Hawaii Center for AIDSUniversity of Hawaii at MānoaHonoluluUSA

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