Characterization of HIV-Associated Neurocognitive Disorders Among Individuals Starting Antiretroviral Therapy in South Africa
HIV-Associated Neurocognitive Disorders (HAND) exert an impact on everyday functions, including adherence. The prevalence of and risk factors for HAND in patients commencing anti-retroviral therapy in Southern Africa are unknown. Participants from primary care clinics in Cape Town, South Africa underwent detailed neuropsychological, neuropsychiatric, and neuromedical evaluation. Using the updated American Academy of Neurology (AAN) criteria, participants were classified into categories of HAND, and demographic and clinical risk factors for HIV-dementia (HIV-D) were assessed. The prevalence of mild neurocognitive disorder (MND) and HIV-D were 42.4 and 25.4%, respectively. There were significant associations between lower levels of education and older age with HIV-D, and a trend to association with HIV-D and lower CD4 count. In a regression model, a lower level of education and male gender were predictive of HIV-D. These findings suggest that HAND are highly prevalent in primary care settings in South Africa where clade C HIV is predominant.
KeywordsHIV-Associated Neurocognitive Disorders HIV-dementia HIV neuropsychology HIV clade
- 2.Heaton RK, Cysique LA, Jin H, Shi C, Yu X, Letendre S, et al. Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China. J Neurovirol. 2008;7:1–14.Google Scholar
- 6.Janssen RS, Cornblath DR, Epstein LG, McArthur J, Price RW. Nomenclature and research case definitions for neurological manifestations of human immunodeficiency virus type-1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology. 1991;41:778–85.Google Scholar
- 12.Starace F, Bartoli L, Aloisi MS, Antinori A, Narciso P, Ippolito G, et al. Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study. Cognitive impairment and depression in HIV/AIDS. The NeuroICONA study. Acta Psychiatr Scand. 2002;106(1):20–6.PubMedCrossRefGoogle Scholar
- 22.Fernhaber C, Reyneke A, Schulze D, Malope B, Maskew M, Macphail P, et al. The prevalence of hepatitis B co-infection in a South African urban government HIV clinic. S Afr Med J. 2008;98:541–4.Google Scholar
- 31.Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests administration, norms, and commentary. 3rd ed. Oxford: Oxford University Press; 2006.Google Scholar