Baseline data from the MSM Neurocog study

Abstract

We present baseline data (follow up due w24–48) from MSM Neurocog - prospective cohort study describing neurocognitive (NC) function in men who have sex with men (MSM) 18–50y.

Objectives

Describe prevalence of positive screen for NC impairment (NCI) using Brief Neurocognitive Screen (BNCS); follow NC function over time.

Data collected

Demographics, medical history, current/nadir CD4, current/peak viral load, antiretroviral (ART) use, recreational drug/tobacco/alcohol use. Subjects screen for depression (PHQ9), anxiety (GAD7), subjective memory problems (Everyday Memory Questionnaire [EMQ]). PHQ9, GAD7, EMQ, IHDS have fixed numerical cut-offs. BNCS interpreted by calculating composite z score for each subject based on distance from mean in three component tests. Comparing to population norms may overcall NCI. We used participants to construct HIV+ normal ranges after exclusion of anxiety/depression, comparing individuals to this range. 235 screened (205 HIV+, 30 HIV−). In HIV+group 59 (28.8%) excluded as GAD7>10, PHQ9>15 or both (2 no data). 144 HIV+ analysed. 124 (86.1%) had normal z score (within 1 SD of mean). 20 (13.9%) had abnormal z: 7 (35%) asymptomatic, 13 (65%) symptomatic (analysed together). Not enough cognitive domains assessed by BNCS to formally diagnose HIV-related NCI. BNCS abnormals less likely to be educated at university level/beyond (40% vs. 62.1%, p=0.02) or in skilled work (45% vs. 81.5%, p<0.0001). Current/ex-recreational drug use similar (~80%); no significant association to score. All patients with abnormal z receiving ART; individual agents not associated with abnormality. IHDS correlated with abnormal BNCS (60% abnormal z had abnormal IHDS vs. 15.3% of normal, p<0.0001). No CD4 association with abnormal z (median nadir 244 in both, p=0.38). Of note, group median age was statistically different but actual difference small (normal 41y vs. abnormal 44y p<0.0001; HIV− 33y). BNCS outcome is age-related but stratification of results would make abnormal numbers too low for interpretation. In any case, no NCI seen following referral. No-one referred for formal psychometric testing after screening shown to have NCI. We show high anxiety, depression and current/previous recreational drug use in HIV+MSM 18–50y. Subjective concerns do not translate into confirmed NCI. Patient pathways should include screening for anxiety/depression and substance use, but in this young MSM group concerns regarding memory/functional impairment seem unfounded.

Reference Winston A, Arenas-Pinto A, Stöhr W, Fisher M, Orkin C, Aderogba K, et al. Factors influencing neurocognitive function in a large cohort of HIV infected patients on effective antiretroviral therapy. Presented at the 13th European AIDS Conference, Belgrade, 2011. Abstract PS2/4.