Background:  With the use of ART, the prevalence of HIV dementia has decreased. However, individuals chronically HIV infected experience mild neurocognitive disorders. We assessed the frequency and factors associated with mild neurocognitive disorders in a large cohort of HIV-infected patients.

Methods:  In a cross-sectional study, a consecutive sample of HIV-infected adults from the ANRS CO3 Aquitaine Cohort has been evaluated with a neuropsychological battery assessing episodic and working memory, executive functions, language, and psychomotor speed. Mild neurocognitive disorder was defined according to the revised research criteria for HIV-associated cognitive disorders as a performance of ≥1 standard deviation below the normative mean in ≥2 neuropsychological tests. Determinants were studied through a multivariate logistic regression model. Moreover, the distribution of subjects’ test scores was divided in quartiles (the lower quartile reflecting poorer performance) and Kruskall-Wallis test was performed to assess the statistical association between cognitive performances and CD4 nadir.

Results:  We have so far enrolled 230 patients (180 men):  median age, 46 years, median CD4 count 505/mm³, 88% treated with ART, and 80% had HIV RNA <500 copies/mL. A mild neurocognitive disorder was diagnosed in 55 patients (24%; 95%CI 18 to 29%). In multivariate analysis, older age (OR = 1.1 for 1 additional year; CI 1.0 to 1.1), professional inactivity or retired status (OR = 2.8 vs professional activity; CI 1.3 to 6.2), low educational level (OR = 13.6 vs graduate patients; CI 4.4 to 42.0), AIDS stage (OR = 2.4, CI 1.0 to 5.3), and positive hepatitis B surface antigen (HBsAg) (OR = 4.0, CI 1.1 to 14.2) were significantly associated with a higher prevalence of mild neurocognitive disorder. A lower nadir of CD4 was significantly associated with the lowest quartile of the scores’ distribution for the following tests:  free and cued selective reminding test (episodic memory), the trail-making test-B (executive functions), and the digit symbol substitution task (psycho-motor speed).

Conclusions:  For every 4 treated adults with well controlled HIV-infection, 1 had a mild cognitive disorder as compared to 6% in the French general population of 65 years or older. In addition to factors usually associated with mild neurocognitive disorders in the aging general population, advanced HIV infection and co-infection with hepatitis B may explain the high frequency in HIV population. A short battery of easy-to-administer tests could be used to explore mild neurocognitive disorders in HIV-infected patients.