To investigate the diagnostic approaches developed in Latin America for HIV-associated neurocognitive disorder (HAND).

HAND is a disease with a difficult diagnosis. While several neurocognitive batteries have been developed in high-income countries, little information is available regarding tools for the Latin American population.

A systematic search was performed in PubMed, Embase, WOS, Cochrane Central, Lilacs, Scielo, CINAHL, and APA PsycINFO for studies conducted until June 22nd, 2023. Studies aiming to assess the diagnostic performance of any tool (psychometric test, neuroimaging technique, or clinical examination) were selected. Only observational and diagnostic accuracy studies were included. Quality assessment was performed using QUADAS-II for diagnostic accuracy studies and Newcastle-Ottawa for observational studies.

A total of 1176 studies were screened, and 12 were included, representing 786 patients. Among them, five studies measured the diagnostic performance of psychometric tests in the Latin American population. In addition, four studies included clinical examination tests, such as Neurological Soft Signs (NSS) and Primitive Reflexes. Moreover, two studies included imaging studies. Finally, only one study evaluated a blood biomarker (macrophage proteomic fingerprinting). Eight studies (66%) did not report diagnostic performance metrics. The better-performing diagnostic approaches were a short neuropsychological battery (sensitivity=92% and specificity=93%) and a blood biomarker (sensitivity=100% and specificity=75%). The quick psychometric tests (IHDS and NEUROPSI) had sensitivity and specificity ranges of 55 to 75% and  38 to 80%, respectively. The quality of the studies ranged from low to medium risk of bias.

Our findings suggest that short versions of neuropsychological batteries have the best diagnostic performance to detect HAND in Latin America. Furthermore, blood biomarkers have promising results as screening tests. However, the lack of availability of these assessments in the region hampers its potential use. Testing and validation of short psychometric and clinical examination tests required further exploration in the region.