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The case for cognitive screening in HIV clinics.

A retrospective chart review was carried out at the HIV clinic in St. James's Hospital, Dublin to examine the rate of cognitive impairment through the use of surrogate markers for cognitive impairment. 500 consecutive hospital charts were reviewed. There were 306 men and 194 women. Median age was 37. The most common mode of transmission was heterosexual. 45% had a nadir CD4 < 200. 78.6% were on antiretroviral therapy and 72.26% were virally suppressed. 69/500 patients (13.8%) had one or more positive surrogate markers for cognitive impairment. The surrogate markers used were subjective complaints, a new onset of a psychiatric diagnosis post diagnosis with HIV, neurological complications and radiological evidence of atrophy. Multivariate analysis using logistic regression showed significant relationships only with gender and year of diagnosis. This figure is lower than reported international prevalence rates of cognitive impairment and demonstrates that surrogate markers are no match for structured cognitive screening. We have since commenced structured prospective screening to obtain a true prevalence of cognitive impairment in this population.