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AIDS and Behavior

, Volume 15, Issue 6, pp 1197–1203 | Cite as

Characterization of HIV-Associated Neurocognitive Disorders Among Individuals Starting Antiretroviral Therapy in South Africa

  • John A. Joska
  • Jennifer Westgarth-Taylor
  • Landon Myer
  • Jacqueline Hoare
  • Kevin G. F. Thomas
  • Marc Combrinck
  • Robert H. Paul
  • Dan J. Stein
  • Alan J. Flisher
Original Paper

Abstract

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.

Keywords

HIV-Associated Neurocognitive Disorders HIV-dementia HIV neuropsychology HIV clade 

References

  1. 1.
    Grant I. Neurocognitive disturbances in HIV. Int Rev Psychiatry. 2008;20(1):33–47.PubMedCrossRefGoogle Scholar
  2. 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
  3. 3.
    Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10(3):317–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Joseph J, Clifford D, Douglas SD, Fox H, Gendelman HE, Gonzalez-Scarano F, et al. Planning future strategies for domestic and international NeuroAIDS research, July 24–25, 2008. J Neuroimmune Pharmacol. 2009;4(3):283–97.PubMedCrossRefGoogle Scholar
  5. 5.
    Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, et al. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS. 2005;19(13):1367–74.PubMedGoogle Scholar
  6. 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
  7. 7.
    Marder K, Albert SM, McDermott MP, McArthur JC, Schifitto G, Selnes OA, et al. Inter-rater reliability of a clinical staging of HIV-associated cognitive impairment. Neurology. 2003;60(9):1467–73.PubMedGoogle Scholar
  8. 8.
    Childs EA, Lyles RH, Selnes OA, Chen B, Miller EN, Cohen BA, et al. Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy. Neurology. 1999;52(3):607–13.PubMedGoogle Scholar
  9. 9.
    Valcour V, Shikuma C, Shiramizu B, Watters M, Poff P, Selnes OA, et al. Age, apolipoprotein E4, and the risk of HIV dementia: the Hawaii Aging with HIV Cohort. J Neuroimmunol. 2004;157(1–2):197–202.PubMedCrossRefGoogle Scholar
  10. 10.
    Chiesi A, Vella S, Dally LG, Pedersen C, Danner S, Johnson AM, et al. Epidemiology of AIDS dementia complex in Europe. AIDS in Europe Study Group. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;11(1):39–44.PubMedCrossRefGoogle Scholar
  11. 11.
    De Ronchi RD, Faranca I, Berardi D, Scudellari P, Borderi M, Manfredi R, et al. Risk factors for cognitive impairment in HIV-1-infected persons with different risk behaviors. Arch Neurol. 2002;59(5):812–8.PubMedCrossRefGoogle Scholar
  12. 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
  13. 13.
    Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, et al. Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med. 2006;7(2):112–21.PubMedCrossRefGoogle Scholar
  14. 14.
    Olley BO, Seedat S, Stein DJ. Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study. J Psychosom Res. 2006;61(4):479–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Mishra M, Vetrivel S, Siddappa NB, Ranga U, Seth P. Clade-specific differences in neurotoxicity of human immunodeficiency virus-1 B and C Tat of human neurons: significance of dicysteine C30C31 motif. Ann Neurol. 2008;63(3):366–76.PubMedCrossRefGoogle Scholar
  16. 16.
    Gupta JD, Satishchandra P, Gopukumar K, Wilkie F, Waldrop-Valverde D, Ellis R, et al. Neuropsychological deficits in human immunodeficiency virus type 1 clade C-seropositive adults from South India. J Neurovirol. 2007;13(3):195–202.PubMedCrossRefGoogle Scholar
  17. 17.
    Joska JA, Fincham DS, Stein DJ, Paul RH, Seedat S. Clinical correlates of HIV-associated neurocognitive disorders in South Africa. AIDS Behav. 2010;14(2):371–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, et al. The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.PubMedGoogle Scholar
  19. 19.
    Myers JK, Weissman MM. Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry. 1980;137(9):1081–4.PubMedGoogle Scholar
  20. 20.
    Saunders JB, Aasland OG, Babor TF, de lF Jr, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction. 1993;88(6):791–804.PubMedCrossRefGoogle Scholar
  21. 21.
    Jacobs GB, Loxton AG, Laten A, Robson B, van Rensburg EJ, Engelbrecht S. Emergence and diversity of different HIV-1 subtypes in South Africa, 2000–2001. J Med Virol. 2009;81(11):1852–9.PubMedCrossRefGoogle Scholar
  22. 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
  23. 23.
    Butters N, Grant I, Haxby J, Judd LL, Martin A, McClelland J, et al. Assessment of AIDS-related cognitive changes: recommendations of the NIMH workshop on neuropsychological assessment approaches. J Clin Exp Neuropsychol. 1990;12(6):963–78.PubMedCrossRefGoogle Scholar
  24. 24.
    Carey CL, Woods SP, Rippeth JD, Gonzalez R, Moore DJ, Marcotte TD, et al. Initial validation of a screening battery for the detection of HIV-associated cognitive impairment. Clin Neuropsychol. 2004;18(2):234–48.PubMedCrossRefGoogle Scholar
  25. 25.
    Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789–99.PubMedCrossRefGoogle Scholar
  26. 26.
    Wong MH, Robertson K, Nakasujja N, Skolasky R, Musisi S, Katabira E, et al. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology. 2007;68(5):350–5.PubMedCrossRefGoogle Scholar
  27. 27.
    McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol. 2005;4(9):543–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Yepthomi T, Paul R, Vallabhaneni S, Kumarasamy N, Tate DF, Solomon S, et al. Neurocognitive consequences of HIV in southern India: a preliminary study of clade C virus. J Int Neuropsychol Soc. 2006;12(3):424–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Sacktor N, McDermott MP, Marder K, Schifitto G, Selnes OA, McArthur JC, et al. HIV-associated cognitive impairment before and after the advent of combination therapy. J Neurovirol. 2002;8(2):136–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Gorman AA, Foley JM, Ettenhofer ML, Hinkin CH, van Gorp WG. Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev. 2009;19(2):186–203.PubMedCrossRefGoogle Scholar
  31. 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
  32. 32.
    Nath A, Schiess N, Venkatesan A, Rumbaugh J, Sacktor N, McArthur J. Evolution of HIV dementia with HIV infection. Int Rev Psychiatry. 2008;20(1):25–31.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • John A. Joska
    • 1
  • Jennifer Westgarth-Taylor
    • 2
  • Landon Myer
    • 3
    • 4
  • Jacqueline Hoare
    • 1
  • Kevin G. F. Thomas
    • 2
  • Marc Combrinck
    • 5
  • Robert H. Paul
    • 6
  • Dan J. Stein
    • 1
  • Alan J. Flisher
    • 1
  1. 1.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  2. 2.ACSENT Laboratory, Department of PsychologyUniversity of Cape TownCape TownSouth Africa
  3. 3.School of Public Health and Family Medicine, Centre for Infectious Diseases Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
  4. 4.International Centre for AIDS Care and Treatment Programs, Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Division of NeurologyUniversity of Cape TownCape TownSouth Africa
  6. 6.Department of Psychology and Behavioral NeuroscienceUniversity of MissouriSt. LouisUSA

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