Evaluation of diagnostic criteria for HIV-associated neurocognitive disorder in the Multicenter AIDS Cohort Study

Since the introduction of combination antiretroviral therapy (cART), individuals with HIV live a fairly normal life, although some develop neurocognitive impairment. HIV-associated neurocognitive disorder (HAND) is the term used to describe these neurocognitive impairments within the HIV population, and include asymptomatic neurocognitive impairment (ANI), mild neurocognitive impairment (MND), and HIV-associated dementia (HAD). The purpose of this paper is to evaluate the diagnostic criteria for HAND used by investigators in the Multicenter AIDS Cohort Study (MACS). Two MACS studies examined the rates of HAND in the HIV+ and HIV- men and found similar prevalence rates of HAND (31.82% and 31.89%), ANI (16.23% and 15.75%), MND (12.99% and 11.81%), and HAD (2.6% and 4.33%). These rates suggest that the methods used to diagnose HAND do an inadequate job to distinguish between HIV+ and HIV- individuals. Better diagnostic criteria for HAND need to be developed to improve classification of the clinical spectrum of HAND. One way to improve the accuracy of diagnosis of HAND is to apply the Rasch analysis when analyzing the diagnostic criteria of MACS. This would help with the monitoring of disease progression, change or adjustment of cART, and identification of risk factors. By monitoring the progression of HAND, clinicians will be able to change or adjust cART as needed and help identify risk factors, which can help to alleviate public health concerns. The public health concerns associated with HAND are unemployment, social decline, lack of adherence to medications, and a poorer quality of life