Risk Factors of Asymptomatic Neurocognitive Impairment in People Living with HIV in an Indian Cohort
Bibliographic record
Abstract
Abstract Background Asymptomatic neurocognitive impairment (ANI) in people living with HIV (PLWH) can lower quality of life, reduce drug compliance, increase unemployment, and reduce life expectancy. Objective This study was aimed to identify risk factors of ANI in PLWH in an Indian cohort and explore the usefulness of Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Score (MoCA) as screening tools. Methods PLWH under follow-up at an antiretroviral treatment center who were 18 to 60 years were included in this study. Patients were excluded if they had any cognitive symptoms, previous history of any central nervous system (CNS) pathology, or any systemic illness. Included patients were subjected to domain wise standardized neuropsychological battery. Six domains were screened including language, attention, speed, memory, sensory motor skills, and executive. Abnormal dysfunctional scores in at least two domains were taken as suggestive of ANI. The two groups thus created, ANI and normal cognition, were evaluated for differences. Variables evaluated as risk factors included age, sex, handedness, education, presence of at least one vascular risk factor, duration of disease, biochemical profile, cluster of differentiation 4 (CD4) count (both current and nadir) HIV viral load, and use of antiretroviral therapy (ART) and its CNS penetration effectiveness (CPE). MMSE and MoCA were also done in all patients. Statistical Analysis Regression analysis was used to find out significant variables. MMSE and MoCA scores were correlated using Spearman’s correlation coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined Results Three hundred and eighty-four patients were included out of which 185 (48%) had ANI. In the multivariate regression analysis, female sex with odds Ratio (OR) of 1.89 (95% confidence interval [CI]: 1.21–2.79, p < 0.01), education below 10 years with OR = 2.43 (95% CI: 1.56–3.80, p < 0.01) and presence of at least one vascular risk factor with OR = 2.52 (95% CI: 1.67–3.80, p < 0.01) were found to be significant. Both MMSE and MoCA had a high PPV (0.99 and 0.97, respectively) but poor NPV (0.64 and 0.75) below a score of 25 with MoCA scoring slightly better. Both, MMSE and MoCA correlated well with each other. Conclusion Nearly half of our patients had ANI, despite being on ART. Majority of patients were on ART with CPE > 7 and had relatively preserved immune status. Female HIV patients with at least one vascular risk factor and less than 10 years of formal education were found to be at risk for ANI. MMSE and MoCA are not good screening tools to identify this condition.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".