Background Because HIV-related neurocognitive impairment is usually mild and variable, clinical ratings (CR) and global deficit scores (GDS) are recommended for detecting HIV-associated neurocognitive disorders (HAND). The CR-approach requires impairment in at least two ability domains; GDS considers number and severity of impairments across all measures. We examined classification agreement and clinical correlates of the two methods. Method Neurocognitive functioning of 1574 HIV-infected participants was assessed via a comprehensive, seven-domain neuropsychological battery. Global neurocognitive impairment was defined for each participant independently by CR and GDS. Participants were classified into four categories (Dually-normal, impaired by CR-only, impaired by GDS-only, or Dually-impaired). Results There was 83% concordance between CR and GDS classifications; in total, 56% of participants were deemed impaired by CR and 41% were classified as impaired by GDS. Impairment by GDS virtually guaranteed CR impairment, but 16% of participants were additionally classified as impaired only by CR. As compared to Dually-normal participants, those classified as Dually and CR-only impaired were more likely to have AIDS, have more severe co-occurring conditions, have more severe depressive symptoms, be unemployed, and have more everyday functioning complaints (ps < 0.05). Conclusion Impairment classifications of the two methods were in high agreement; however, more people were classified as impaired using the CR-approach compared to the GDS approach, and those impaired according to CR-only showed fewer neurocognitive and functional deficits than the Dually-impaired participants. The CR approach may be most appropriate for detecting more subtle forms of neurocognitive impairment. Clinicians and researchers should recognize the strengths and weaknesses of each method when evaluating neurocognitive complications in HIV.

Background HIV-associated neurocognitive disorders (HAND) include both “asymptomatic” and “symptomatic” neurocognitive impairment. Asymptomatic diagnoses indicate HAND without demonstrable functional impairment. The present study compares three approaches to assess functional decline: 1) self-report measures only (SR); 2) performance-based measures only (PB); and 3) combining SR and PB measures (SR+PB). Methods We assessed 674 HIV-infected research volunteers with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via SR and PB measures. HAND diagnoses in these 233 cognitively impaired individuals were determined according to published criteria, which allow for both SR and PB methods in establishing functional decline. Results The dual-method diagnosed the most symptomatic (53%; 124/233) HAND conditions, compared to either singular method, which were only 59% concordant. Participants classified as functionally-impaired via PB were more likely to be unemployed, more immunosuppressed, and had more hepatitis-C co-infection, whereas those classified via singular SR were more depressed. Conclusions Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. PB-based classification was associated with objective functional status (i.e., employment) and important disease-related factors, whereas the typical SR singular classifications may be biased by depressed mood.

The present study assesses the impact of methamphetamine (METH) on antiretroviral (ART) adherence among HIV+ persons, as well as examines the contribution of neurocognitive impairment and other neuropsychiatric factors (i.e., major depressive disorder (MDD), Antisocial Personality Disorder (ASPD), and Attention Deficit Disorder (ADHD)) for ART nonadherence. We examined HIV+ persons with DSM-IV-diagnosed lifetime history of METH abuse/dependence (HIV+/METH+; n = 67) as compared to HIV+ participants with no history of METH abuse/dependence (HIV+/METH−; n = 50). Ancillary analyses compared these groups with a small group of HIV+/METH+ persons with current METH abuse/dependence (HIV+/CU METH+; n = 8). Nonadherence was defined as self-report of any skipped ART dose in the last four days. Neurocognitive functioning was assessed with a comprehensive battery, covering seven neuropsychological domains. Lifetime METH diagnosis was associated with higher rates of detectable levels of plasma and CSF HIV RNA. When combing groups (i.e., METH+ and METH− participants), univariate analyses indicated co-occurring ADHD, ASPD, and MDD predicted ART nonadherence (p’s<0.10; not lifetime METH status or neurocognitive impairment). A significant multivariable model including these variables indicated that only MDD uniquely predicted ART nonadherence after controlling for the other variables (p<0.05). Ancillary analyses indicated that current METH users (use within 30 days) were significantly less adherent (50% prevalence of nonadherence) than lifetime METH+ users and HIV+/METH-participants, and that neurocognitive impairment was associated with nonadherence (p’s<0.05). METH use disorders are associated with worse HIV disease outcomes and ART medication nonadherence. Interventions often target substance use behaviors alone to enhance antiretroviral treatment outcomes; however, in addition to targeting substance use behaviors, interventions to improve ART adherence may also need to address coexisting neuropsychiatric factors and cognitive impairment to improve ART medication taking.