Patient selection: HIV positive
Parameters:
(1) age
(2) months of current CART (combination antiretroviral therapy of at least 3 drugs) duration in months
(3) current CD4-positive lymphocyte count in number per µL
(4) history of HIV-related CNS disease (value 0 if negative, 1 if positive)
(5) cognitive deficits
discriminant HAND score =
= (0.377 * (age)) - (0.004 * (CD4 cell count)) + (2.5 * (history of CNS disease)) - (0.165 * (months of current CART)) -14.99
A discriminent score >= 0 indicates increased risk for HAND.
|
HAND Score
|
Cognitive Deficit
|
Interpretation
|
|
< 0
|
absent
|
repeat evaluation in 1 year
|
|
< 0
|
present
|
consider cognitive screen or full neurological evaluation
|
|
>= 0
|
absent
|
consider cognitive screen or full neurological evaluation
|
|
>= 0
|
present
|
refer for full neurological evaluation
|
If HAND is diagnosed:
(1) Consider modifying CART for greater CNS penetration.
(2) Verify adherence.
(3) Evaluate activities of daily living (ADL).
(4) Consider psychiatric assessment.
(5) Develop a strategy for assistance and intervention.
Performance:
• The accuracy of neuropsychological impairment prediction was 78%.
• The accuracy of neuropsychological nonimpairment was 70%.
