AIDS and Behavior

, Volume 21, Issue 6, pp 1717–1727 | Cite as

Use of Western Neuropsychological Test Battery in Detecting HIV-Associated Neurocognitive Disorders (HAND) in Zambia

  • Norma Kabuba
  • J. Anitha Menon
  • Donald R. FranklinJr.
  • Robert K. Heaton
  • Knut A. Hestad
Original Paper

Abstract

This is a study of neuroAIDS in sub-Saharan Africa, involving 266 Zambian adults infected with the human immunodeficiency virus (HIV), clade C. All HIV+ participants were receiving combination antiretroviral therapy (CART), and were administered a comprehensive neuropsychological (NP) test battery covering seven ability domains that are frequently affected by neuroAIDS. The battery was developed in the U.S. but has been validated in other international settings and has demographically-corrected normative standards based upon 324 healthy Zambian adults. Compared to the healthy Zambian controls, the HIV+ sample performed worse on the NP battery with a medium effect size (Cohen’s d = 0.64). 34.6 % of the HIV+ individuals had global NP impairment and met criteria for HIV associated neurocognitive disorder (HAND). The results indicate that the Western-developed NP test battery is appropriate for use in Zambia and can serve as a viable HIV and AIDS management tool.

Keywords

HIV HAND Neuropsychological performance Zambia 

Resumen

Este es un estudio sobre neuroAIDS en Africa subsahariana donde los estudiados fueron 266 adultos Zambianos infectados con virus de inmunodefiencia adquirida (VIH)  tipo C. Todos los participantes con VIH recibieron terapia antirretroviral (CART) y sometido a una batería de pruebas neuropsicológicas (NP) que examinan capacidades cognitivas que a menudo se ven afectadas por el neuroSIDA. Dicha batería fue elaborada en Estados unidos pero ha sido validada en entornos internacionales y ha sido corregida demograficamente según los estandares normativos de una seleccion de 324 adultos zambianos sin VIH. Comparados con los zambianos sin SIDA en el grupo de control los VIH-positivos muestran resultados peores en la batería neuropsicológica con un efecto de proporción mediana (Cohen’s d = 0.64). 34.6 % de los participantes con VIH tuvieron un deterioro neuropsicológico global y cumplían los criterios de un trastorno neurocognitivo asociado con el VIH (HAND). Estos resultados indican que la batería neuropsicológica elaborada en Estados Unidos (desarrollada en Occidente) es un instrumento adecuado y viable para su uso en Zambia y puede funcionar como una herramienta de gestión del VIH.

Palabras Clave

VIH HAND Rendimiento neuropsicológico Zambia 

Notes

Acknowledgements

Gratitude is extended to the staff and patients of the participating clinics for their contributions. The authors also thank the first and second cohort Masters students in clinical neuropsychology at The University of Zambia for their contribution in collecting the data of the healthy sample and the seropositive sample respectively. The study was financially supported by the NOMA funds from The Norwegian Agency for Development Cooperation (NORAD).

Funding

The study was financially supported by the NOMA funds from The Norwegian Agency for Development Cooperation (NORAD). Project title: Master of Science in Clinical Neuropsychology—Building expertise to deal with the Neuropsychological challenges of HIV-infection. (Grant No NOMAPRO-2007/10046).

Compliance with Ethical Standards

Conflict of interest

Norma Kabuba declares that she has no conflict of interest. J. Anitha Menon declares that she has no conflict of interest. Donald R. Franklin Jr. declares that he has no conflict of interest. Robert K. Heaton declares that he has no conflict of interest. Knut A. Hestad declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Heaton R, Grant I, Butters N, White DA, Kirson D, Atkinson HJ, McCuthchan JA, Taylor M, Kelly MD, Ellis RJ, Wolfson T, Velin RA, Marcotte TD, Hesselink JR, Jernigan TL, Chandler J, Wallace M, Abramason I. The HNRC 500-Neuropsychology of HIV infection at different disease stages. J Int Neuropsychol Soc. 1995;1(231):251.Google Scholar
  2. 2.
    Heaton RK, Clifford DB, Franklin DR Jr., Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, AbramsonI, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I, the CHARTER Group HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Clin Infect Dis. 2015;60(3):473–80. doi: 10.1093/cid/ciu862. Epub 2014.
  3. 3.
    Reger MA, Martin DJ, Sherwood LC, Strauss G. The relationship between viral load and neuropsychological functioning in HIV-1 infection. Arch Clin Neuropsychol. 2005;20:137–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Garrido JM, Alvarez M, Lopez MA. Neuropsychological impairment and gender differences in HIV-1 infection. Psychiatry Clin Neurosci. 2008;62:494–502.CrossRefGoogle Scholar
  5. 5.
    Durvasula RS, Norman, LR, Malow R Current perspectioves on neuropsychology of HIV’ 177–190 in HIV/AIDS global frontiers in prevention/intervention. Pope C, White CRT, Malow R (eds). New York: Tylor and Francis; (2009)Google Scholar
  6. 6.
    Robertson K, Liner J, Heaton R. Neuropsychological assessment of HIV-Infected populations in international settings. Neuropsychol Rev. 2009;19:232–49. doi: 10.1007/s11065-009-9096-z.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Parsons TD, Braaten AJ, Hall CD, Robertson KR. Better quality of life with neuropsychological improvement on HAART. Health Qual Life Outcomes. 2006;4:11. doi: 10.1186/1477-7525-4-11.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sacktor N. The epidemiology of human immunodeficiency virus- associated neurological disease in the era of highly active antiretroviral therapy’. J Neurovirol. 2002;8(Suppl 2):115–21. doi: 10.1080/13502802901094.CrossRefPubMedGoogle Scholar
  9. 9.
    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. doi: 10.1007/s11065-009-9095-5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sacktor N, Wong M, Nakasujja N, Skolasky R, Selnes O, Musisi S, Roberston K, McArthur J, Ronald A, Katabira E. The international HIV dementia scale: a new rapid screening test for HIV dementia. AIDS. 2005;19:1367–74.PubMedGoogle Scholar
  11. 11.
    Sacktor N, Nakasujja N, Robertson K, Clifford DB. HIV-associated cognitive impairment in sub-Saharan Africa–the potential effect of clade diversity. Nat Clin Pract Neurol. 2007;3(8):436–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Lawler K, Mosepele M, Ratcliffe S, Seloilwe E, Nthobatsang R, Steenhoff A. Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study. J Int AIDS Soc, 2010;13:15 http://www.jiasociety.org/content/13/1/15.
  13. 13.
    Maj M, D’Elia L, Satz P, Janssen R, Zaudig M, Uchiyama C, Starace F, Galderisi S, Chervinsky A. Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. Arch Clin Neuropsych. 1993;8:123–35.CrossRefGoogle Scholar
  14. 14.
    Robertson KR, Nakasujja N, Wong M, Musisi S, Katabira E, Parsons TD, Ronald A, Sacktor N. Pattern of neuropsychological performance among HIV patients in Uganda BMC Neurol. 2007;7:8. doi: 10.1186/1471-2377-7-8.PubMedGoogle Scholar
  15. 15.
    Stringer JSA, Zulu I, Stringer EM, Mwango A, Chi BH, Mtonga V, Reid S, Cantrell RA, Bulterys M, Saag MS, Marlink RG, Mwinga A, Ellerbrock TV, Sinkala M. Rapid scale-up of antiretrovial therapy at primary care sites in Zambia-feasibility and early outcomes. JAMA. 2006;296:782–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Meyers A. Neuroloy and the global HIV epidemic. Semin Neurol. 2014;34:70–7.CrossRefGoogle Scholar
  17. 17.
    Jackson H. AIDS Africa—continent in crisis. Harare: SAfAIDS; 2002.Google Scholar
  18. 18.
    UNAIDS (2012). ‘Global Report 2012: AIDSinfo’ http://www.unaids.org/en/regionscountries/countries/zambia/retrieved 30/04/15.
  19. 19.
    Zambia Demographic and Health Survey [ZDHS], (2013–14): https://dhsprogram.com/pubs/pdf/FR304/FR304.pdf retrieved 28/07/15.
  20. 20.
    Cysique LA, Brew BJ. Neuropsychological functioning and antiretroviral treatment in HIV/AIDS: a review’ neuropsychol. Review. 2009;19:169–85. doi: 10.1007/s11065-009-9092-3.Google Scholar
  21. 21.
    Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99. doi: 10.1212/01.WNL.0000287431.88658.8b.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, Grant I. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10(03):317–31.CrossRefPubMedGoogle Scholar
  23. 23.
    Blackstone K, Moore DJ, Heaton RK, Franklin DR, Woods SP, Clifford DB, Morgello S. Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning. J Int Neuropsychol Soc. 2012;18(01):79–88.CrossRefPubMedGoogle Scholar
  24. 24.
    Habib AG, Yakasai AM, Owolabi LF, Ibrahim A, Habib ZG, Gudaji M, Karaye KM, Ibrahim DA, Nashabaru I. Neurocognitive impairment in HIV-1- infected adults in Sub-Saharan Africa: a systemtic review and meta-analysis. Int J Infect Dis. 2013;17:e820–31. doi: 10.1016/j.ijid.2013.06.011.CrossRefPubMedGoogle Scholar
  25. 25.
    Robertson K, Kumwenda J, Supparatpinyo K, Jiang H, Evans S, Campbell TB, Price RW, Murphy R, Hall C, Marra CM, Marcus C, Berzins B, Masih R, Santos B, Silva MT, Kumarasamy N, Walawander A, Nair A, Tripathy S, Kanyama C, Hosseirnipour M, Montano S, La Rosa A, Amod F, Sanne I, Firnhaber C, Hakim J, Brouwers P, the AIDS Clinical Trials Group. A multinational study of neurological performance in antiretroviral Therapy-Naïve HIV-1 infected persons in diverse resource-constrained settings. J Neurovirol. 2011;18(5):438–47. doi: 10.1007/s13365-011-0044-3.CrossRefGoogle Scholar
  26. 26.
    Holguin A, Banda M, Willen EJ, Malama C, Chiyenu KO, Mudenda VC, Wood C. HIV-1 effects on neuropsychological performance in a resource—limited country, Zambia. AIDS Behav. 2011;15:1895–1901. doi:10.10071510461-011-9988-9.Google Scholar
  27. 27.
    Potchen MJ, Siddiqi OK, Elafros MA, Theodore WH, Sikazwe I, Kalungwana L, Bositis CM, Birbeck GL. Neuroimaging abnormalities and seizure recurrence in a prospective cohort study of Zambians with human immunodeficiency virus and first seizure. Neurol Int. 2014;6:5547.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Hestad KA, Menon JA, Serpell R, Kalungwana L, Kabuba N, Mwaba S, Franklin D Jr., Heaton RK. Demographically corrected neuropsychological test norms from Zambia, Africa. Psychol Assess. 2015; http://dxdoi.org11o.1037/pas 0000147.Google Scholar
  29. 29.
    Stemler SE, Chamvu FC, Chart H, et al. Assessing competencies in reading and mathematics in Zambian children. In: Grigorenko E, editor. Multicultural Psyhoeducational Assessment. New York: Springer Publishing company; 2008. p. 157–85.Google Scholar
  30. 30.
    Heaton RK, Cysique LA, Jin H, Shi C, Yu X, Letendre S, Franklin DR Jr, Ake C, Vigil O, Atkinson JH, et al. Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China. J Neurovirol. 2008;14(6):536–49.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Heaton RK, Miller SW, Taylor MJ, Grant I. Revised comprehensive Norms for an expanded Halstead Reitan Battery: demographically adjusted neuropsychological norms for African American and Causasian Adults. Luitz FL: Psychol Assess Res Inc; 2004.Google Scholar
  32. 32.
    Kabuba N, Menon JA, Hestad K. Moderate alcohol consumption and cognitive functioning in a Zambian population. MJZ. 2011;38:2Google Scholar
  33. 33.
    Hestad AK, Menon JA, Ngoma M, Franklin DR, Imasiku MI, Kalima K, Heaton RK. Sex differences in the Neuropsycholgical performance as an effect of Human Immunodeficiency Virus infection-A pilot study in Zambia, Africa. Acta Scandinavia 2012;200(4).Google Scholar
  34. 34.
    Kanmogne GD, Kuate CT, Cysique LA, Fonsah JY, Eta S, Doh R, Njamnishi DM, Nchindap E, Franklin DR Jr, Ellis RJ, McCutchan JA, Binam F, Mbanya D, Heaton RK, Njamnshi AK. HIV-associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon’ BMC Neurology 2010,10:60 http://www.biomedcentral.com/1471-2377/10/60.
  35. 35.
  36. 36.
    Clifford DB, Evans S, Yang Y, Acosta EP, Ribaudo H, Gulick RM. Long-term impact of Efavirenz on neuropsychological performance and symptoms in HIV-infected individuals (ACTG5097s). HIV Clin Trials. 2009;10(6):343–55. doi: 10.1310/hct1006-343.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Vance DE, Fazeli PL, Gakumo CA. The impact of Neuropsychological performance on everyday functioning between older and younger Adults with and without HIV. J Assoc Nurses AIDS Care. 2013;24(2):112–25. doi: 10.1016/j.jana.2012.05.002.CrossRefPubMedGoogle Scholar
  38. 38.
    Bell MJ, Terhorst L, Bender CM. Psychometric analysis of the patient assessment of own functioning inventory in women with breast cancer. J Nurs Meas. 2013;21(2):320–34.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Rourke SB, Halman MH, Bassel C. Neuropsychiatric correlates of memory-metamemory dissociations in HIV-infection. J Clin Exp Neuropsychol. 1999;21(6):757-68.Google Scholar
  40. 40.
    Chelune GJ. Lehman RAW. Neuropsychological and personality correlates of patients complaints of disability. In: Goldstein G, Tarter RE, editors. Advances in clinical neuropsychology. New York: Plenum Press; 1986. p. 95–118.CrossRefGoogle Scholar
  41. 41.
    Blackstone K, Moore DJ, Franklin Jr. DR, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthu, JC, Morgello SD, Simpson M, Ellis RJ, Atkinson JH, Grant I, Heaton, RK, for the CHARTER Group Defining Neurocognitive Impairment in HIV: Deficit Scores versus Clinical Ratings Clin Neuropsychol. 2012; 26(6): doi: 10.1080/13854046.2012.694479.
  42. 42.
    Carey C, Woods SP, Gonzalez R, Conover E, Marcotte TD, Heaton RK. Predictive validity of Global Deficit Scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26(3):307–19.CrossRefPubMedGoogle Scholar
  43. 43.
    Ettenhofer ML, Hinkin CH, Castellon SA, Durvasula R, Ullman J, Lam M, Foley J. Aging, neurocognition, and medication adherence in HIV infection. Am J Geriatr Psychiatry. 2009;17(4):281–90. doi: 10.1097/JGP.0b013e31819431bd.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Gupta JD, Satishchandra P, Gopukumar K, Wilkie F, Waldrop-Valverde D, Ellis R, Ownby R, Subbakrishna DK, Desai A, Kamat A, et al. Neuropsychological deficits in human immunodeficiency virus type 1 clade C-seropositive adults from South India. J Neurovirol. 2007;13(3):195–202.CrossRefPubMedGoogle Scholar
  45. 45.
    Muñoz-Moreno JA, Fumaz CR, Ferrer MJ, Prats A, Negredo E, Garolera M, Núria Pérez-Álvarez N, Moltó J, Gómez G, Clotet B. Nadir CD4 cell count predicts neurocognitive impairment in HIV-infected patients. AIDS Res Hum Retroviruses. 2008;24(10):1301–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Lawler K, Kealeboga J, Mosepele M, Ratcliffe SJ, Cherry C, Seloilwe E, Steenhoff AP. Neurobehavioral Effects in HIV-Positive Individuals Receiving Highly Active Antiretroviral Therapy (HAART)in Gaborone, Botswana. PLoS One. 2011;6(2):e17233. doi: 10.1371/journal.pone.0017233.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Clifford DB, Mitike MT, Mekonnen Y, Zhang J, Zenebe G, Melaku Z, Zewde A, Gessesse N, Wolday D, Messele T, et al. Neurological evaluation of untreated human immunodeficiency virus infected adults in Ethiopia. J Neurovirol. 2007;13(1):67–72.CrossRefPubMedGoogle Scholar
  48. 48.
    Heaton RK, Franklin DR, Ellis RJ, Mc Cutchan JA, Letendre SL, Le Blanc S, Collier AC. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17(1):3–16.CrossRefPubMedGoogle Scholar
  49. 49.
    Thames AD, Foley JM, Panos SE, Singer EJ, El-Saden S, Hinkin CH. Cognitive reserve masks neurobehavioral expression of human immodeficiency virus-associated neurological disorder in older patients. Neurobehav HIV Med. 2011;3:87–93. doi: 10.2147/NBHIVS25203retrieved25/09/2013.CrossRefGoogle Scholar
  50. 50.
    Ganasen KA, Fineham D, Smit TK, Seedat S, Stein D. Utility of the HIV Dementia Scale (HDS) in identifying HIV dementia in a South African sample. J Neurol Sci. 2008;269:62–4.CrossRefPubMedGoogle Scholar
  51. 51.
    Joska JA, Westgarth-Taylor J, Myer L, et al. Characterization of HIV-associated neurocognitive disorders among individuals starting antiretroviral therapy in South Africa. AIDS Behav. 2010;. doi: 10.1007/s10461-010-9744-6.PubMedGoogle Scholar
  52. 52.
    Zambia Ministry of Health. 2010, Adult and Adolescent Antiretroviral Therapy ProtocolsGoogle Scholar
  53. 53.
    Zambian National AIDS Council. National guidelines for management and care of patients with HIV/AIDS. Lusaka: Printech Press; 2004.Google Scholar
  54. 54.
    Marcotte TD, Lazzaretto D, Scott JC, Roberts E, Woods SP, Letendre S. Visual attention deficits are associated with driving accidents in cognitively-impaired HIV-infected individuals. J Clin Exp Neuropsychol. 2006;28(13):28.Google Scholar
  55. 55.
    Raper JL. The medical management of HIV disease. In: Durham JD, Lashley FR, editors. The person with HIV/AIDS. 4th ed. New York: Springer; 2010.Google Scholar
  56. 56.
    Albert SM, Weber CM, Todak G, Polanco C, Clouse R, McElhiney M, Marder K. An observed performance test of medication management ability in HIV: relation to neuropsychological status and medication adherence outcomes. AIDS Behav. 1999;3(2):121–8.CrossRefGoogle Scholar
  57. 57.
    Shahriar J, Delate T, Hays RD, Coons SJ. Commentary on using the SF-36 or MOS-HIV in studies of persons with HIV disease. Health Qual Life Outcomes. 2003;1(1):1.CrossRefGoogle Scholar
  58. 58.
    Marcotttee TD, Scott JC, Kamat R, Heaton RK (2010). Neuropsychology and the prediction of everyday functioning. In Marcottee TD, Grant I (Ed) Neuropsychology of everyday functioning (pp. 5–38). Guilford Press: New York.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Norma Kabuba
    • 1
    • 2
  • J. Anitha Menon
    • 1
  • Donald R. FranklinJr.
    • 3
  • Robert K. Heaton
    • 3
  • Knut A. Hestad
    • 2
    • 4
    • 5
  1. 1.Department of PsychologyThe University of ZambiaLusakaZambia
  2. 2.Department of PsychologyThe Norwegian University of Science and TechnologyTrondheimNorway
  3. 3.Department of PsychiatryUniversity of California, San DiegoSan DiegoUSA
  4. 4.Department of ResearchInnlandet Hospital TrustHamarNorway
  5. 5.Hedmark University CollegeElverumNorway

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