2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Neuropsychological testing – mixed picture

Normal (> -1SD)

Mild/moderate (-1≤ x> -2SD)

Severe (≤ -2SD)

FrascatiDomain

Score

CVLT-II trial 5

10 10

0.0 1.0 0.0

CVLT-II ImmediateRecall CVLT-II DelayedRecall

Memory

7

Visual memory impairment Language impairment

BensonFigurerecall

9

-1.57

BostonNamingTest (15 item) Category fluency (animals)

12 12 20 68

-2.88

-2.3

Language

Lexical fluency (Dwords)

0.82

WRAT-4

X

SentenceComprehension

4 8 6 5

-0.5

CVLT-II trial 1 Digits forward Digits backward

2.0

-0.64

Attention/

0.0

STROOP Interference

46 25 65

-0.56

WorkingMemory

1-back 2-back TrailsB

-1.06

0.17

149 ”

-1.31

DesignFluency

8

-0.97

Executive

Flanker Modified Trails Abstraction/similarities

24 ”

TrailsA

0.73

Psychomotorspeed

STROOPcolornaming

83

-0.62

88 ”

GroovedPegboard (Dominanthand)

-0.06

137 ”

GroovedPegboard (non-Dominanthand)

-1.77

Manual dexterity and speed decreased, often seen in HIV

Motor

FingerTapping (Dominanthand)

35.4

-1.00

FingerTapping (non-Dominanthand)

34.4

-1.35

BensonFigure copy

16

0.45

Visuo-spatial

VOSP

8

-0.83

CATSFaceMatching

10

-2.83

Slide 31of46FromVValcour,MD,PhDatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

Case Report - Neuroimaging

Read as normal for age

Slide 32of46FromVValcour,MD,PhDatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

Case Report - Next Steps?

 Modification of ARVs for greater CNS penetration? - No evidence to support this approach for a 10-year course - Most people are undetectable – thus CSF HIV RNA seldom linked to impairment  Initiation of cholinesterase inhibitors for Alzheimer’s disease? - Would be empiric and possibly wrong Watch and wait - Natural longitudinalcourse is likely to distinguish the two over 3 years - Could implement broad recommendations withoutdiagnostic clarity - Reasonable, but would you want this for yourself? 

 CSF assessment for neurodegenerative biomarkers or referral to a specialist?

Slide 33of46FromVValcour,MD,PhDatNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.