Neurocognitive impairment, depression, and anxiety in HIV‐1‐infected patients across western Europe and Canada: the CRANIum study ‐ ethnicity analysis
Authors: Elbirt D , Bayon C , Robertson K , Sambatakou H , McNamara P , Kulasegaram R , Schembri G , de Alvaro C , Cabrero E , Guion M , Norton M , Van de Steen O , van Wyk J 
Published: April 2013

Purpose of the studyThe prevalence of neurocognitive impairment (NCI) in people living with HIV has previously been reported between 20–50%, with prevalence rates of depression reported between 12–71%. The primary objective of the CRANIum study was to describe the prevalence of a positive screen for NCI and depression/anxiety in an HIV‐1‐infected adult population, comparing ARV‐naïve and ‐experienced patients. Here we present an ethnicity analysis of the CRANIum data.MethodsThe study was an epidemiologic, cross‐sectional study that included HIV‐1‐infected patients >18 years old attending a routine clinic visit. One‐third of patients were ART‐naïve, one‐third on a PI/r‐ and one‐third on a NNRTI‐based regimen. The Brief Neurocognitive Screen (BNCS) was used to screen for NCI. It consists of the Digit Symbol and Trailmaking A and B tests. A standard deviation of >1 on 2 tests or >2 on 1 test was considered a positive screen for NCI. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety (HADS‐A) and depression (HADS‐D). HADS is self‐administered and consists of 14 items (7 HADS‐A, 7 HADS‐D) scored between 0 to 3. A score of ≥8 was considered as a positive screen for either condition.Summary of results2859 evaluable patients were included from 15 countries. Baseline characteristics are shown in table 1 (*p < 0.05 as compared with Caucasian group). Overall, 41.4% of patients had a positive screen for NCI, 33.3% for anxiety and 15.7% for depression. Results by ethnicity are shown in figure 1.

All subjects
Caucasian
Black
Hispanic
Oriental/Asian
Other

Number of subjects (%)
2859
2254 (78.8)
387 (13.5)
127 (4.4)
50 (1.7)
41 (1.4)

Age ‐ mean, years
42.95
43.80
39.79*
38.56*
40.57*
42.96

Gender ‐%

‐ Male
61.7
67.3
26.9*
70.1
64.0
56.1

‐ Female
38.3
32.7
73.1*
29.9
36.0
43.9

Unemployed ‐%
33.1
32.8
35.7
26.0
30.0
51.2*

> Secondary school education ‐%
82.2
81.3
84.2
89.0*
90.0
78.0

HIV risk factor ‐%

‐ Homosexual
42.5
48.5
4.1*
58.3*
36.0
31.7

‐ Heterosexual
44.8
37.3
89.4*
39.4*
46.0
51.2

‐ Other/ Not known
12.8
14.2
6.5*
2.4*
18.0
17.1

Duration of HIV infection – mean, months
98.10
103.22
73.46*
79.80*
82.16
113.84

Last recorded HIV‐1 RNA level

‐ ART‐naïve‐ median, c/mL
22,390
23,539
11,483
32,241
23,112
12,660

‐ ART‐experienced – median, c/mL
39.0
39.0
40.0
28.0
40.0
39.5

Last recorded CD4 count – mean, c/µL
586.02
598.70
527.57*
550.17
542.40
599.43

Previous AIDS diagnosis ‐%
17.5
17.7
16.6
17.3
16.0
19.5

Previous CNS infection ‐%
4.5
3.6
7.2*
6.3
6.0
17.1*

CD4 count nadir (mean, cells/µL)
295.02
302.65
255.01*
311.97
259.10
247.63

Hepatitis C co‐infection ‐%
12.4
14.7
1.6*
3.9*
16.0
12.2

Previous psychiatric diagnosis ‐%
20.2
22.2
9.8*
15.9
20.0
17.1

imageConclusionsIn this large epidemiologic study, the overall prevalence of a positive screen for NCI was high. In particular, the rate in black patients was nearly double that of the overall study population. This finding needs to be interpreted in light of differences in demographics and disease characteristics between ethnic groups. The overall prevalence of a positive screen for depression in HIV‐infected patients was nearly double what has previously been reported in the non‐HIV‐infected population in Europe when utilizing a similar screening tool, with no significant differences between identified ethnic groups. These results support a strategy of regular screening for, and clinical management of NCI, depression, and anxiety in all HIV‐infected patients, with specific focus on NCI in the black population.