Addressing Cognitive Symptoms in People With HIV: Outcomes From a Holistic Screening and Management Pathway
Bibliographic record
Abstract
OBJECTIVE: To describe the implementation and outcomes of a cognitive screening and management pathway in people living with HIV within a large UK HIV service. METHODS: Since 2021, cognitive symptoms have been screened during routine HIV appointments using the cognitive screening questions endorsed by the European AIDS Clinical Society. Symptomatic individuals underwent the Montreal Cognitive Assessment; scores <26/30 prompted referral to a dedicated HIV-Memory clinic. Pathway data from 2021 to 2023 were retrospectively analyzed. Baseline and follow-up neuropsychological test results were compared. Cognitive impairment was defined by global and domain-specific Z scores, and changes in cognitive performance were evaluated using global deficit and reliable change index scores compared with norms through t-tests. The interventions delivered were quantified. RESULTS: Of the 2662 individuals attending the HIV service, 1518 (57%) received screening; 155 (10%) reported symptoms (mean age was 59.5 ± 11.6; 93.5% VL <40 copies/ml). In total, 71 (46% then completed a Montreal Cognitive Assessment) and 33 individuals (46.5%) scored <26. Among 136 HIV-Memory clinic attendees, 38 were followed up to track cognitive progression and intervention impact. 196 interventions were delivered, including comorbidity/lifestyle management (n = 33,31%), mental health support (n = 22, 19%), HIV-therapy adjustment (n = 16, 11%), and cognitive remediation (n = 11, 6%). Improvements were seen in global cognitive and most domains, notably delayed memory and executive function (both P < 0.03). CONCLUSIONS: Implementing a cognitive screening and management pathway in routine HIV care is feasible. In individuals receiving management, cognitive performance generally remained stable or improved, highlighting the potential benefit of personalized interventions addressing holistic factors associated with cognitive impairment in people with HIV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".