P-52 Asymptomatic neurocognitive impairment in people living with HIV infection (PLWH): are we misdiagnosing for someone?
Bibliographic record
Abstract
<h3>Background</h3> HIV-Associated Neurocognitive Disorders (HAND) include a spectrum of cognitive, motor and mood problems affecting People Living With HIV (PLWH). For a comprehensive neurocognitive assessment, at least 2 tests for each cognitive domain should be administered. Aim of this study was to examine the prevalence of neurocognitive impairment (NCI) in neurocognitive asymptomatic PLWH attending our outpatient clinics. <h3>Methods</h3> 116 subjects without a previous diagnosis of psychiatric or cerebrovascular events, aged over 18 years, on Antiretroviral treatment (ARV) with an undetectable HIV RNA viremia from more than 1 year, were screened by the same doctor during last autumn routine check-up visits. Attention, concentration, executive functions, memory, language, visuoconstructive skills, abstraction, calculation, and orientation were assessed with an Italian version of Montreal Cognitive Assessment (MoCA) test. The administration time for the MoCA test is 10 minutes; the maximum score is 30 points; a score ≥26/30 is considered normal. Moreover, the following parameters were analyzed: sex, age, CD4 cells count, CD4 nadir, HIV RNA viremia, length of time of ARV treatment, antiretroviral regimen (INSTI based or not, 2DR vs 3DR, NUC sparing), years of schooling, <h3>Results</h3> Among 116 examined subjects, 85 (73%) were male, median age 52 (IQR 42–60) median length of exposition to antiretroviral treatment 10 (IQR 4,7–20.2) years. All of them had HIV RNA viremia below 200 copies/ml: 109 (94%) <50 copies/ml, 67 (58%) TND. Median CD4 nadir 252 (IQR 107–457) cells/µl. Median CD4 cell count 781 (IQR 540–996) cells/µl. Median years of schooling 13 (IQR 8–13). The median MoCA score was 24 (21–26). Thirty one (27%) subjects had a normal value. A Spearman correlation was detected between MoCA score and age (r=-0.26; two tailed p=0.0048); schooling (r=0.335; two tailed p=0.0002); CD4 nadir (r=0.216; two tailed p= 0.02); years of treatment (r=0.233; two tailed p=0.012) (figure 1). No statistical differences were seen regarding normal MoCa score with last CD4 cell count, HIV RNA viremia, ARV regimen, therapeutic strategy. <h3>Discussion</h3> Just a quarter of PLWH screened in this cross sectional analysis performed a normal MoCA score. Age, schooling, longer exposition to ARV treatment and lower CD4 cell count nadir could be potentially associated with pathological score. Cognitive test performances could be strongly influenced by complex educational, cultural and socioeconomic factors which can interact with HIV risk. As a consequence, Frascati criteria could mis-classify over 20% of cognitively healthy individuals as having cognitive impairment. In the era of the effective ARV treatment and ageing for PLWH, cognitive impairment is frequently multifactorial and, hence, is not inevitably a result of the direct effect of HIV on the brain. Nevertheless, a comprehensive neurocognitive assessment should be periodically performed in clinical setting to prevent undesirable impairment.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".