Cysique et al developed an algorithm for identifying HIV-associated neurocogntiive disorders (HAND) in HIV-positive patients. This can help to identify a patient who may require a more in-depth assessment. The authors are from University of New South Wales and St. Vincent's Hospital in Sydney, Australia.


Patient selection: HIV positive



(1) age

(2) months of current CART (combination antiretroviral therapy of at least 3 drugs) duration in months

(3) current CD4-positive lymphocyte count in number per µL

(4) history of HIV-related CNS disease (value 0 if negative, 1 if positive)

(5) cognitive deficits


discriminant HAND score =

= (0.377 * (age)) - (0.004 * (CD4 cell count)) + (2.5 * (history of CNS disease)) - (0.165 * (months of current CART)) -14.99


A discriminent score >= 0 indicates increased risk for HAND.

HAND Score

Cognitive Deficit


< 0


repeat evaluation in 1 year

< 0


consider cognitive screen or full neurological evaluation

>= 0


consider cognitive screen or full neurological evaluation

>= 0


refer for full neurological evaluation


If HAND is diagnosed:

(1) Consider modifying CART for greater CNS penetration.

(2) Verify adherence.

(3) Evaluate activities of daily living (ADL).

(4) Consider psychiatric assessment.

(5) Develop a strategy for assistance and intervention.



• The accuracy of neuropsychological impairment prediction was 78%.

• The accuracy of neuropsychological nonimpairment was 70%.


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