Operationalizing and evaluating the Frascati criteria for functional decline in diagnosing HIV-associated neurocognitive disorders in adults

The Frascati criteria for HIV-associated neurocognitive disorders (HAND; Antinori et al. 2007) outlines a classification scheme for functional decline that-despite being over a decade old-has not heretofore been examined systematically. Participants included 307 HIV+ and 183 HIV- participants who completed self-report, clinician-rated, and performance-based measures of functional status, along with neurocognitive, psychiatric, and medical/laboratory assessments. Using the Frascati criteria, we classified participants with (1) no functional declines, (2) mild functional declines, or (3) major functional declines. A multivariable logistic regression showed that HIV serostatus was associated with higher rates of major (33.2 vs. 13.7%) but not mild (38.8 vs. 31.7%) Frascati-defined functional decline. Within the HIV+ group, individuals with global neurocognitive impairment and affective disorders were at highest risk of Frascati-defined functional decline. Findings provide some empirical support for the sensitivity and validity of the Frascati criteria for functional declines in the context of HAND. Future work is needed to determine the reliability, stability, cross-cultural validity, and downstream health-related consequences of the Frascati-defined functional classifications.