Journal of NeuroVirology

, Volume 23, Issue 3, pp 404–421 | Cite as

A comparison of the sensitivity, stability, and reliability of three diagnostic schemes for HIV-associated neurocognitive disorders

  • Savanna M. Tierney
  • David P. Sheppard
  • Victoria M. Kordovski
  • Marika P. Faytell
  • Gunes Avci
  • Steven Paul Woods
Article

Abstract

HIV-associated neurocognitive disorders (HAND) occur in approximately 50% of HIV-infected individuals, yet available diagnostic criteria yield varying prevalence rates. This study examined the frequency, reliability, and sensitivity to everyday functioning problems of three HAND diagnostic criteria (DSM-5, Frascati, Gisslén). Participants included 361 adults with HIV disease and 199 seronegative adults. Neurocognitive status as defined by each of the three diagnostic systems was determined via a comprehensive neuropsychological battery. Everyday functioning was evaluated through self-report and clinician ratings. Results of logistic regressions revealed an association of HIV serostatus with Frascati-defined neurocognitive impairment (p = .027, OR = 1.7[1.1, 2.7]), but not DSM-5 or Gisslén-defined criteria (ps > .05). Frascati and DSM-5 criteria demonstrated agreement on 71% of observations, Frascati and Gisslén showed agreement on 80%, and DSM-5 and Gisslén criteria showed agreement on 46%, though reliability across the three criteria was poor. Only Frascati-defined neurocognitive impairment significantly predicted everyday functioning problems (p = .002, OR = 2.3[1.4, 3.8]). However, when both neurocognitive and complaint criteria were considered, the DSM-5 guidelines demonstrated significant relationships to everyday functioning, serostatus, and also increased reliability overtime compared to neurocognitive criteria alone (all ps < .05). A subset (n = 118) of the HIV+ group was assessed again after 14.0 (2.2) months. DSM-5 criteria evidenced significantly higher rates of incident neurocognitive disorder compared to both Frascati (p = .003) and Gisslén (p = .021) guidelines, while there were fewer remitting neurocognitive disorder diagnoses when Gisslén criteria were applied to the study sample compared to Frascati (p = .04). Future studies should aim to identify gold standard biological markers (e.g., neuropathology) and clinical outcomes associated with specific diagnostic criteria.

Keywords

HIV Neuropsychology Neurocognitive disorders Diagnosis 

Notes

Acknowledgements

The authors have no financial conflicts of interest related to this work. This study was supported by NIH grants R01-MH073419 and P30-MH62512. 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 for 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 US Government. The authors thank the study volunteers for their participation.

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Copyright information

© Journal of NeuroVirology, Inc. 2017

Authors and Affiliations

  • Savanna M. Tierney
    • 1
  • David P. Sheppard
    • 1
  • Victoria M. Kordovski
    • 1
  • Marika P. Faytell
    • 1
  • Gunes Avci
    • 1
  • Steven Paul Woods
    • 1
  1. 1.Department of PsychologyUniversity of HoustonHoustonUSA

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