The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67343

Kimberley D Lucas, MPH¹, Joseph A. Bick, MD², Jennifer K Baham, MPH³, Deborah Harriss, RNP², Seema Mittal, BS³, and Juan D. Ruiz, MD, DrPH¹. (1) HIV/AIDS Epidemiology Branch, Office of AIDS, California Department of Health Services, MS 7700, PO Box 942732, Sacramento, CA 94234, 916-650-6902, klucas@dhs.ca.gov, (2) California Medical Facility, California Department of Corrections, 1600 California Drive, Vacaville, CA 95687, (3) Office of AIDS, Epidemiology Branch, California Department of Health Services, MS 7700, PO Box 942732, Sacramento, CA 94234

Background: HIV-Associated Dementia (HAD) is a progressive neurological and AIDS-defining disorder characterized by cognitive impairment, psychomotor slowing, and behavior abnormalities affecting 25 to 65% of AIDS patients and up to 15% of asymptomatic HIV-1-infected persons. HAD is particularly challenging for the incarcerated, and has not previously been studied in this population. Methods: Male HIV-1-infected inmates (n=239) were assessed for HAD using HIV Dementia Scale (HDS) and Executive Interview (EXIT) neuropsychological screening. Demographic, behavioral, and clinical risk assessment surveys and medical chart abstractions were completed. Results: Ninety-two (38.5%) and 22 (16.3%) of patients screened positive for HAD by HDS and EXIT respectively. Contrary to previous findings, both HDS and EXIT scores were highly influenced by education level (p<0.0001). Patient–reported daily alcohol use was significantly associated with poorer EXIT performance (p=0.02). In univariate analyses HDS and EXIT scores were not significantly associated with having an AIDS diagnosis, current or nadir CD4 counts, current or past HAART or AZT therapy, HCV co-infection, history of head trauma, psychiatric diagnoses, or intravenous drug use. Bivariate and multivariate analyses continue. Conclusion: The discrepancy between HDS and EXIT and the higher than expected prevalence of HAD estimated by HDS, given the correctional facility’s directly observed antiretroviral therapy, are likely due to lower education and other confounding factors common in incarcerated populations. HDS and EXIT cut-off scores validated in predominantly white, highly educated populations are not appropriate for use in an incarcerated population. We recommend standardization of HDS and EXIT cut-off scores using incarcerated HIV-seronegative controls.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to:
• 1. List and describe the three major symptoms of HIV-associated dementia.
• 2. Describe neuropsychological screening for HIV-associated dementia, providing examples of test items from the HIV Dementia Scale and Exit Interview screening instruments.
• 3. Discuss the behavioral and clinical characteristics of incarcerated HIV-infected patients which may place them at increased risk for HIV-associated dementia.

Keywords: Dementia, Correctional Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Handout (.ppt format, 138.5 kb)