Addressing cognitive symptoms in people with HIV: Outcomes from a holistic screening and management pathway.

Abstract

Objective: To describe the implementation and outcomes of a cognitive screening and management pathway in people living with HIV within a large UK HIV service.

Methods: Since 2021, cognitive symptoms have been screened during routine HIV appointments using the cognitive screening questions endorsed by the European AIDS Clinical Society. Symptomatic individuals underwent the Montreal Cognitive Assessment (MoCA); scores <26/30 prompted referral to a dedicated HIV-Memory clinic. Pathway data from 2021-2023 were retrospectively analysed. Baseline and follow-up neuropsychological test results were compared. Cognitive impairment was defined by global and domain-specific Z scores, and changes in cognitive performance were evaluated using global deficit and reliable change index scores compared to norms via t-tests. The interventions delivered were quantified.

Results: Of the 2662 individuals attending the HIV service, 1518 (57%) received screening; 155 (10%) reported symptoms (mean age was 59.5 ± 11.6; 93.5% VL <40 copies/ml). 71 (46% then completed a MoCA), and 33 (46.5%) scored <26. Among 136 HIV-Memory clinic attendees, 38 were followed up to track cognitive progression and intervention impact. 196 interventions were delivered, including comorbidity/lifestyle management (n=33,31%), mental health support (n=22, 19%), HIV-therapy adjustment (n=16, 11%) and cognitive remediation (n=11, 6%). Improvements were seen in global cognitive and most domains, notably delayed memory and executive function (both p<0.03).

Conclusions: Implementing a cognitive screening and management pathway in routine HIV care is feasible. In individuals receiving management, cognitive performance generally remained stable or improved, highlighting the potential benefit of personalised interventions addressing holistic factors associated with cognitive impairment in people with HIV.