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A multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings

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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.

Potential conflicts of interest

R.W. Price is involved in an investigator-initiated grant funding for Merck and honorarium for a lecture for Abbott Laboratories.

Author information

Authors and Affiliations

  1. University of North Carolina, Chapel Hill, NC, USA

    Kevin Robertson, Colin Hall & Cheryl Marcus

  2. Queen Elizabeth, Blantyre, Malawi

    Johnstone Kumwenda

  3. Chiang Mai University, Chiang Mai, Thailand

    Khuanchai Supparatpinyo

  4. Harvard University, Boston, MA, USA

    Jeanne H. Jiang & Scott Evans

  5. University of Colorado–Denver, Aurora, CO, USA

    Thomas B. Campbell

  6. University of California, San Francisco, CA, USA

    Richard W. Price

  7. Northwestern University, Chicago, IL, USA

    Robert Murphy & Baiba Berzins

  8. University of Washington, Seattle, WA, USA

    Christina M. Marra

  9. Social & Scientific Systems, Inc., Silver Springs, MD, USA

    Reena Masih

  10. Porto Alegre, Brazil

    Breno Santos

  11. Fiocruz, Rio De Janeiro, Brazil

    Marcus T. Silva

  12. Chennai, India

    N. Kumarasamy

  13. Frontier Science & Technology Research Foundation, Buffalo, NY, USA

    Ann Walawander & Apsara Nair

  14. Pune, India

    Srikanth Tripathy

  15. Lilongwe, Malawi

    Cecilia Kanyama & Mina Hosseinipour

  16. Lima, Peru

    Silvia Montano & Alberto La Rosa

  17. Durban, South Africa

    Farida Amod

  18. Johannesburg, South Africa

    Ian Sanne & Cindy Firnhaber

  19. Harare, Zimbabwe

    James Hakim

  20. National Institute of Mental Health, Bethesda, USA

    Pim Brouwers

  21. Department of Neurology, University of North Carolina, 2128 Physician Office Building, 170 Manning Drive, Chapel Hill, NC, 27599-7025, USA

    Kevin Robertson

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  1. Kevin Robertson
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  2. Johnstone Kumwenda
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  3. Khuanchai Supparatpinyo
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  5. Scott Evans
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  6. Thomas B. Campbell
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  7. Richard W. Price
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  9. Colin Hall
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  14. Breno Santos
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  15. Marcus T. Silva
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  16. N. Kumarasamy
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  17. Ann Walawander
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  18. Apsara Nair
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  19. Srikanth Tripathy
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  20. Cecilia Kanyama
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  21. Mina Hosseinipour
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  22. Silvia Montano
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  23. Alberto La Rosa
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  24. Farida Amod
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  25. Ian Sanne
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  26. Cindy Firnhaber
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  27. James Hakim
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the AIDS Clinical Trials Group

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Correspondence to Kevin Robertson.

Additional information

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

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