One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV

José Damas; Katharine E A Darling; Phanie Bidlingmeyer; Isaure Nadin-Debluë; Mélanie Bieler; Lidia Vollino; Arseny A Sokolov; Alexandre Berney; Giorgio Maccaferri; Paraskevas Filippidis; Benjamin Viala; Cristina Granziera; Vincent Dunet; Renaud Du Pasquier; Matthias Cavassini

doi:10.1111/hiv.13472

One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV

HIV Med. 2023 Jun;24(6):738-748. doi: 10.1111/hiv.13472. Epub 2023 Mar 8.

Authors

José Damas¹, Katharine E A Darling¹, Phanie Bidlingmeyer¹, Isaure Nadin-Debluë², Mélanie Bieler^{1

3}, Lidia Vollino³, Arseny A Sokolov⁴, Alexandre Berney⁵, Giorgio Maccaferri⁶, Paraskevas Filippidis¹, Benjamin Viala⁷, Cristina Granziera⁸, Vincent Dunet⁹, Renaud Du Pasquier¹⁰, Matthias Cavassini¹

Affiliations

¹ Department of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
² Laboratory of Neuroimmunology, Research Centre of Clinical Neurosciences, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁵ Service of Psychiatry, Department of Liaison Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁶ Adult Psychiatry Service-North and University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁷ Department of Infectious Diseases, Centre Hospitalier Alpes Léman, Contamine-sur-Avre, France.
⁸ Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Department of Neurology, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2MB), University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ Department of Medical Radiology, Service of Diagnostic and Interventional Radiology, Neuroradiology Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁰ Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

PMID: 36890672
DOI: 10.1111/hiv.13472

Abstract

Background: With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach.

Methods: People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced.

Results: Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants.

Conclusions: Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.

Keywords: HIV; ageing; multidisciplinary management of HIV; neuro-HIV; neurocognitive impairment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aging
Comorbidity
HIV Infections* / complications
HIV Infections* / psychology
Humans
Middle Aged
Neuropsychological Tests
Surveys and Questionnaires