One for all, all for one: neuro‐HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV.

HIV infection complications; COGNITION disorders; INTERDISCIPLINARY research; COMMUNICABLE diseases; TIME; MAGNETIC resonance imaging; RISK assessment; NEUROPSYCHOLOGICAL tests; AGING; LUMBAR puncture; DESCRIPTIVE statistics; POLYNEUROPATHIES; RESEARCH funding; DISEASE management; PSYCHOLOGY of HIV-positive persons; COMORBIDITY; EVALUATION

Background: With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time‐consuming and logistically demanding. We developed a neuro‐HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach. Methods: People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt‐out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced. Results: Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV‐associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non‐HIV‐associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV‐1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV‐RNA was detectable in 18.4% out of 185 participants. Conclusions: Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non‐HIV causes of NCI. A 1‐day evaluation system is beneficial for both participants and referring physicians. [ABSTRACT FROM AUTHOR]