AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #244 - Establishing an HIV neurocognitive screening service in clinical practice
Authors: Presenting Author: Ms Breda Ward - Chelsea and Westminster Hospital NHS Foundation Trust
Additional Authors: Dr. Tristan Barber, Dr. Shamela De Silva, Dr. Susan Thornton, Dr. Denise Ratcliffe, Dr. Alexander Margetts, Dr. Edwina Williams, Dr. David Asboe, Dr. Anton Pozniak, Prof. Brian Gazzard, Dr. Marta Boffito, Dr. Jose Catalan,
Aim: We aimed to establish a weekly neurocognitive screening clinic in our HIV service for those aged 18-50 years in collaboration with our Psychological Medicine department.
Method / Issue: Controversies include how best to screen for neurocognitive problems in those infected with HIV, actual impact on functional and subjective quality of life in those with asymptomatic/moderate impairment, and the contribution of cortical and subcortical processes to observed deficits. Work in our Unit to date has focussed on screening those aged over 50. It seems likely that those living with HIV may develop brain impairment in two main groups – those developing age-associated dementia (possibly earlier than in a non-HIV infected cohort as for other non-AIDS conditions) and those developing brain impairment at a younger age, possibly associated with HIV itself, central nervous system opportunistic infection, antiretroviral drugs, coinfection (e.g. hepatitis C) or other risk factors such (e.g. use of recreational drugs). Our clinic Referrals: • HIV infected • 18-50 (50+ to be referred to Aging Clinic) • Any HIV infected patient with suspected neurocognitive impairment (NCI) or with a request to undergo NCI screening for any other reason: o PRIOR to referral for any other investigations or to psychological medicine o on/off antiretroviral therapy (ART) o primarily suspected of having NCI secondary to HIV, ART, hepatitis coinfection/treatment o may also have a history of past or current alcohol/recreational drug use • Patients with neurological/psychiatric problems should be investigated and referred onwards (e.g. to neurology/psychiatry) as appropriate rather than referred to this clinic initially Relevant tests prior to appointment: • Routine clinic bloods including syphilis testing • Hepatitis serology as indicated Clinic procedure and onward referral: • Patients will undergo screening for anxiety (GAD-7), depression (PHQ-9), neurocognitive impairment (International HIV Dementia Score (IHDS), Trailmaking A (TMA) and B (TMB), Digit Symbol Testing (DST)) and memory (Everyday Memory Questionnaire (EMQ)) • Further investigations may be indicated including: o MRI scanning o Lumbar puncture o Psychological Medicine referral (formal neuropsychometric testing)  The aim is for HIV infected patients to be screened before onward referral to psychology • Recruitment to research studies offered as available Recommendations may include the following: • No action/no abnormality • Review and further testing at future time point • Onward referral as above • Appropriate antiretroviral therapy o If indicated – to be discussed at local HIV “Virtual Clinic” and with referring physician
Results / Comments: To date we have been running for 8 weeks and have seen 6 patients. 2 patients was referred for further assessment on the basis of a high anxiety and depression score and 1 was referred for formal neuropsychometric testing given significant EMQ and IHDS scores. 1 was already under psychiatric care. 2 patients were referred for MRI brain scans and 3 had had them recently. A lumbar puncture was recommended for 1 patient.
Discussion: We intend to keep assessing the impact and delivery of this clinic in collaboration between our departments.
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