Validity of Cognitive Screens for HIV-Associated Neurocognitive Disorder: A Systematic Review and an Informed Screen Selection Guide

Various screening tools have been proposed to identify HIV-Associated Neurocognitive Disorder(HAND). However, there has been no systematic review of their strengths and weaknesses in detecting HAND when compared to gold standard neuropsychological testing. Thirty-five studies assessing HAND screens that were conducted in the era of combination antiretroviral therapy were retrieved using standard search procedures. Of those, 19 (54 %) compared their screen to standard neuropsychological testing. Studies were characterised by a wide variation in criterion validityprimarily due to non-standard definition of neurocognitiveimpairment, and to the demographic and clinical heterogeneity of samples. Assessment of construct validitywas lacking, and longitudinal useability was not established. To address these limitations, the current review proposed a summary of the most sensitive and specific studies (>70 %), as well as providing explicit caution regarding their weaknesses, and recommendations for their use in HIV primary care settings.