Assessing cognitive impairment in HIV-infected: a comparative study of international HIV Dementia Scale, HIV Dementia Scale Italian version and Montreal cognitive assessment in clinical practice

The combination of antiretroviral therapy (cART) and preventive measures has significantly enhanced the management of Human Immunodeficiency Virus (HIV) infection. However, HIV-associated neurocognitive disorders (HAND) remain a challenge. This study aims to compare cognitive impairment (CI) assessments in people living with HIV/AIDS (PLWHA) using the International HIV Dementia Scale (IHDS), HIV Dementia Scale-Italian Version (HDS-IT) and MoCA (Montreal Cognitive Assessment), while also identifying significant associations. The cross-sectional study encompassed 294 outpatient PLWHA (median age: 57) on cART. Participants underwent cognitive, functional, and depression assessments, laboratory testing and CNS Penetration-Effectiveness (CPE) index assessment. IHDS, HDS-IT and MoCA identified CI in different proportions of PLWHA. Factors such as age, education level, infection duration, and substance use were associated with CI. The IHDS score (OR 0.79) and Level CD4 + T-lymphocytes nadir (OR 0.99) demonstrated independent and negative associations with the CPE-index. IHDS and MoCA tests appear to be useful for detecting CI in outpatient settings, enabling healthcare providers to conduct initial evaluations of PLWHA. IHDS assessment may be used for detecting CI related to high CPE regimens, while the MoCA provides a comprehensive assessment, also in domains not studied by IHDS. However, further research is needed to confirm these findings and refine their clinical applicability.