Page 171 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP5.1 Healthcare Advances, Research and Innovations 09:00 Room 221

HIV-associated Neurocognitive Disorders (HAND) Clinic — Early Detection of HIV-associated Neurocognitive

Disorders
Chan I 1, Li KK 2, Lee MP 1, Chung WY 1, Yu PC 1, Wong HY 1
1AIDS Clinical Service, 2Department of Clinical Psychology, Queen Elizabeth Hospital, Hong Kong

Introduction

HIV enters the central nervous system early in the course of the infection and leads to profound and widespread damage to
the central nervous system. HIV-associated neurocognitive disorders (HAND) can range from subtle, subsyndromic deficits
to frank and severe form of dementia. The diagnosis of HIV can bring emotional impacts to an individual, which resulted in
cognitive complaints. Therefore, differential diagnosis of HAND and mood disorders is important for the provision of timely
treatment to patients. We have established a HAND clinic for newly-diagnosed HIV positive patients who attended AIDS
Clinical Service of Queen Elizabeth Hospital.

Objectives Tuesday, 19 May

(1) To allow early detection of HAND and clinical mood disorders; (2) to offer timely medical and neuropsychological treatment
to maximise the chance of reversing HAND and mood disorders; and (3) to set up a standardised and protocol-based
screening service to enhance patient care.

Methodology

Newly-diagnosed HIV positive outpatients of AIDS Clinical Service received a HAND screening. The screening tools included
the International HIV Dementia Scale (IHDS), Montreal Cognitive Assessment (MoCA-HK), Hospital Anxiety Depression
Scale (HADS) and Depression, as well as Anxiety and Stress Scale (DASS). The screening was conducted by a Psychology
Assistant (PA). When patients showed neurocognitive impairment in the screening and impairment in daily functioning,
a battery neuropsychological test will be offered by a clinical psychologist to the patients. Patients who were identified
suffering from clinical mood disorders would receive psychological interventions. All patients received a follow-up screening
at the sixth month after the first screening.

Results

As at December 2014, 82 newly diagnosed HIV+ patients received the first screening between December 2013 and
December 2014. 73 (89%) were males and nine (11%) were females. Among them, 39 patients have already received a follow-
up screening at the sixth month. During the first screening, six patients (7.3%) showed significant cognitive impairment,
27 patients (32.9%) showed mood disturbance, five patients (6.1%) showed both cognitive and mood disturbance and 43
patients (52.4%) were free from any cognitive or mood disturbance. Detailed neurocognitive assessment at follow-up were
offered to the 11 patients who shown cognitively impaired in screening, and confirmed that about 73% of them suffered
from significant neurocognitive disorders. Psychological interventions were given to those emotionally disturbed. A total of
39 patients have received a second screening. Significant improvement in cognition and mood, as measured by IHDS and
HADS, was observed at the sixth month.

Conclusion

(1) HAND screening by PA is cost-effective; (2) medical and neuropsychological service to HIV-infected patients is enhanced;
and (3) HAND screening provides objective monitoring of treatment progress and outcome.

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