Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Grant I. Neurocognitive disturbances in HIV. Int Rev Psychiatry. 2008;20(1):33–47.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  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 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google 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 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  27. McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol. 2005;4(9):543–55.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  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 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    John A. Joska, Jacqueline Hoare, Dan J. Stein & Alan J. Flisher

  2. ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa

    Jennifer Westgarth-Taylor & Kevin G. F. Thomas

  3. School of Public Health and Family Medicine, Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa

    Landon Myer

  4. International Centre for AIDS Care and Treatment Programs, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Landon Myer

  5. Division of Neurology, University of Cape Town, Cape Town, South Africa

    Marc Combrinck

  6. Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, MO, USA

    Robert H. Paul

Authors
  1. John A. Joska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Westgarth-Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Landon Myer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacqueline Hoare
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin G. F. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc Combrinck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert H. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dan J. Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alan J. Flisher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John A. Joska.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Joska, J.A., Westgarth-Taylor, J., Myer, L. et al. Characterization of HIV-Associated Neurocognitive Disorders Among Individuals Starting Antiretroviral Therapy in South Africa. AIDS Behav 15, 1197–1203 (2011). https://doi.org/10.1007/s10461-010-9744-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-010-9744-6

Keywords

Search

Navigation