Abstract
Little is known about how the prevalence and incidence of neurological disease in HIV-infected patients in resource-limited settings. We present an analysis of neurological and neurocognitive function in antiretroviral naïve individuals in multinational resource-limited settings. This prospective multinational cohort study, a substudy of a large international randomized antiretroviral treatment trial, was conducted in seven low- and middle-income countries in sub-Saharan Africa, South America, and Asia. Subjects were HIV-infected and met regional criteria to initiate antiretroviral therapy. Standardized neurological examination and a brief motor-based neuropsychological examination were administered. A total of 860 subjects were studied. Overall 249 (29%) had one or more abnormalities on neurological examinations, but there was a low prevalence of HIV-associated dementia (HAD) and minor neurocognitive disorder (MND). Twenty percent of subjects had evidence of peripheral neuropathy. There were significant differences across countries (p < 0.001) in neuropsychological test performance. In this first multinational study of neurological function in antiretroviral naïve individuals in resource-limited settings, there was a substantial prevalence of peripheral neuropathy and low prevalence of dementia and other CNS diseases. There was significant variation in neurocognitive test performance and neurological examination findings across countries. These may reflect cultural differences, differences in HIV-related and unrelated diseases, and variations in test administration across sites. Longitudinal follow-up after antiretroviral treatment initiation may help to define more broadly the role of HIV in these differences as well as the impact of treatment on performance.
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Acknowledgements
The project described was supported by the National Institute of Mental Health, and the AIDS Clinical Trials Group (ACTG) funded by The National Institute of Allergy and Infectious Diseases (NIAID) Award Number U01AI068636, General Clinical Research Center (GCRC) funded by the National Center for Research Resources, and SDAC Grant Number AI-068634. The content is solely the responsibility of the above authors and does not necessarily represent the official views of the NIAID or the National Institutes of Health (NIH). The authors were supported by the following grants: Deise Vieira and Marcus Tulius T. Silva, IPEC-FIOCRUZ (Site 12101) CTU Grant no. AI69476; Umesh Lalloo and Rosie Mngqibisa, Durban Adult HIV CRS (Site 11201) CTU Grant no. 5U01AI069426-03; Nagalingeshwaran Kumarasamy and Jabin Sharma, YRGCARE Medical Centre (Site 11701) CTU Grant no. AI069432; Virginia M. Kayoyo and Franklin D. Kilembe, Franklin Kilembe University of North Carolina Project, Kamuzu Central Hospital, Lilongwe (Site 12001) CTU Grant no. AI069518; Mauleen Waison and Rachel Mahachi-Parirenyatwa CRS (Site 30313) CTU Grant no. BRS-ACURE-Q-08-00173- TOOI-OOO; Cynthia Firnhaber and Daphne S. Radebe, Wits HIV Clinical Research Site (Helen Joseph Hosp) (Site 11101) CTU Grant no. AI069463; BRS-ACURE-Q-07-00143 T006; Thira Sirisanthana and Daralak Tavornprasit, Research Institute for Health Sciences, Chiang Mai University (Site 11501) CTU Grant no. AI069399; AACTG.27.5199.06; Maria Siliprandi and Renata Londero, Hospital Nossa Senhora da Conceicao CRS (Site 12201) CTU Grant no. 5 U01 AI069401; Anjali A. Joglekar and Srikanth Prasad Tripathy, NARI Pune CRS (Site 11601) CTU Grant no. 5U01AI069417-03; Ben Kalonga and Henry Chamba, College of Medicine, Johns Hopkins Project (Site 30301) CTU Grant no. U01A1069518; Carlos Mosquera and Rosa Infante, INMENSA-Lince CRS (Site 11302) CTU Grant no. 5U01 AI069438-03; BRS- ACURE-Q-07-00141-T001-001; Juan Carlos Hurtado and Alberto La Rosa, Asociación Civil Impacta Salud y Educación (Site 11301) CTU Grant no. AI069438; BRS-ACURE-Q-08-00007-T-002; Manisha V. Ghate and Madhura Nene, NARI-NIV Clinic (Site 11603) CTU Grant no. 5U01AI069417-03; Dr. Raman Gnagakhedkar and Usha Katti, Dr. Kotnis Dispensary, NARI (Site 11602) CTU Grant no. 5U01AI069417-03.
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R.W. Price is involved in an investigator-initiated grant funding for Merck and honorarium for a lecture for Abbott Laboratories.
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The authors wish to dedicate this manuscript to Dr. Jens Mielke, who died during the conduct of the study. He is missed by all who knew him.
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Robertson, K., Kumwenda, J., Supparatpinyo, K. et al. A multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings. J. Neurovirol. 17, 438–447 (2011). https://doi.org/10.1007/s13365-011-0044-3
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DOI: https://doi.org/10.1007/s13365-011-0044-3