Assessing Risk of HIV-Associated Neurocognitive Disorder

Abstract

Background: People with HIV (PLHIV) are aging, and 20% are at risk of developing a neurological complication known as HIV-associated neurocognitive disorder (HAND). Signs and symptoms of HAND may be subtle; however, treatment can improve clinical outcomes.

Objective: The aim of the study was to identify and agree on a risk assessment and monitoring process for the regular review of patients at risk of HAND.

Methods: Between March and September 2017, 25 experts from four community healthcare services participated in three rounds of a modified Delphi study to reach consensus on the items, monitoring period, and format of assessment tools to identify risk of HAND in PLHIV in the community.

Results: More than 80% consensus was reached at all three Delphi rounds. A flow chart, an initial assessment, and an annual monitoring tool were developed for an ongoing assessment of risk of developing HAND.

Conclusion: Twenty percent of PLHIV may develop HAND, a treatable condition. The use of a modified Delphi method led to the successful development of two risk assessment tools to identify those at risk of HAND. The initial assessment tool may be used as a precursor to formal assessment by medical and nursing staff, whereas the annual monitoring tool may assist community-based health professionals in their ongoing assessment of risk of HAND in PLHIV, facilitating early formal medical review for this condition.