One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV. HIV Medicine
Damas et al. describe the implementation of a multidisciplinary neuro-HIV platform, which aims at providing a comprehensive neurocognitive assessment.
In the Lausanne University Hospital (CHUV), specialists from the departments of infectious diseases (ID), neurology, neuropsychology, and psychiatry collaborate closely when evaluating the neurocognitive function of people with HIV, and provide a multidisciplinary assessment and recommendations within 8 hours.
Neuropsychological assessments are performed using tests that best reflect the patients’ complaints, and are focused on instrumental functions (e.g. language), memory, executive function and attention. A psychiatric evaluation is performed to estimate the extent to which cognitive problems could be attributed to psychopathology (e.g. depression). Examinations include an MRI to assess for alternative neurological disease, and a lumbar puncture to detect HIV central nervous system viral escape and to measure drug concentrations in the cerebrospinal fluid.
Between March 2011 and April 2019, 185 individuals were evaluated within the framework of the neuro-HIV platform (median age 54 yeast, 58.9% were men). HIV-associated neurocognitive impairment was diagnosed in 37 individuals, of whom 24 (65%) had asymptomatic neurocognitive impairment, 11 (30%) had mild neurocognitive disorder, and 2 (5%) had HIV-associated dementia. HIV viral escape was present in 16 of 143 individuals who underwent a lumbar puncture (median HIV-RNA 49 cp/mL, IQR 35-190). Depression was the most important non-HIV cause, which accounted for 79.5% of individuals with non-HIV related neurocognitive impairment.
In summary, the present work nicely illustrates the feasibility and benefits of addressing neurocognitive symptoms in a timely and comprehensive manner, as recommended in the European AIDS Clinical Society guidelines. The high prevalence of non-HIV related causes for neurocognitive impairment such as depression further underlines the importance of a multidisciplinary approach.