Skip to main content

Advertisement

SpringerLink
Log in

HIV-1 Effects on Neuropsychological Performance in a Resource-Limited Country, Zambia

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

Abstract

Zambia has substantially been affected by the HIV/AIDS epidemic with prevalence rates at 14% in a population estimated at 12 million. Yet, the extent of HIV-associated neurocognitive disorders (HAND) in this population remains to be clearly understood. A series of culturally appropriate neuropsychological (NP) assessments [International HIV Dementia Scale (IHDS), Color Trails Test 1 and 2, Grooved pegboard Test, and Time Gait Test] were used to test the effects of HIV on NP performance of HIV seropositive and seronegative individuals. Twenty-two percent HIV positive individuals ARV naïve met the criteria for IHDS-defined NP impairment. Gender significantly influenced the performance on NP tests with females performing more poorly compared to males. Larger studies that will accommodate gender differences and age are necessary to generate appropriate norms in Zambia in order to better assess the prevalence of HAND in the developing country setting.

Resumen

Zambia ha sido significamente afectado por la epidemia de VIH/SIDA, con tasas de prevalencia del 14% en una población estimada en 12 millones. Sin embargo, en cuestión a los trastornos neurocognitivos asociados con el VIH (TNAV) aún se desconoce en esta población. Una serie de evaluaciones neuropsicológicas (NP) culturalmente apropiados [Escala Internacional de Demencia asociada a VIH (EIDAV), las Pruebas Color Trails™ 1 y 2, La prueba tablero ranurado de clavijas, y la prueba del tiempo de marcha] se utilizaron para probar los efectos del VIH en el rendimiento NP de personas VIH seropositivos y seronegativas. Veintidós por ciento de las personas VIH positivas sin manejo previo con antiretrovirales cumplieron con los criterios de un deterioro NP definido como EIDAV. El genero influyo importantemente en el desempeño en las pruebas NP, con un rendimiento mas pobre en las femeninas en comparación con los masculinos. Estudios de mayores dimensiones que tomen en cuenta las diferencias de género y edad son necesarios para generar normas adecuadas en Zambia con el fin de evaluar mejor la prevalencia de los TNAV en el escenario de los países en desarrollo.

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. UNAIDS Report on the global AIDS epidemic 2010. Available at: http://www.unaids.org/globalreport/default.htm. Accessed Sep 2010.

  2. Grewal HM, Gupta S, Singh S. Opportunistic pathogens in AIDS: trends, diagnosis and priorities. Expert Rev Anti Infect Ther. 2008;6(2):163–6.

    Article  PubMed  Google Scholar 

  3. Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.

    Article  PubMed  CAS  Google Scholar 

  4. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann Neurol. 1986;19:524–7.

    Google Scholar 

  5. Janssen RS, Nwanyanwu OC, Selik RM, Sehr-Green JK. Epidemiology of human immunodefciency virus encephalopathy in the United States. Neurology. 1992;42:1473–6.

    Google Scholar 

  6. Epstein LG, Sharer LR, Gajdusek DC. Hypothesis: AIDS encephalopathy is due to primary and persistent infection of the brain with a human retrovirus of the lentivirus subfamily. Med Hypotheses. 1986;21(1):87–96.

    Article  PubMed  CAS  Google Scholar 

  7. Heaton RK, Marcotte TD, Rivera Mindt M, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004;10:317–31.

    Article  PubMed  Google Scholar 

  8. Sacktor N, Skolasky RL, Ernst T, et al. A multicenter study of two magnetic resonance spectroscopy techniques in individuals with HIV dementia. J Magn Reson Imaging. 2005;21(4):325–33.

    Article  PubMed  Google Scholar 

  9. McArthur J, Hoover DR, Bacellar H, et al. Dementia in AIDS patients: incidence and risk factors. Neurology. 1993;43:2245–51.

    PubMed  CAS  Google Scholar 

  10. Belec L, Martin PMV, Vohito MD, et al. Low prevalence of neuro-psychiatric clinical manifestations in central Africa patients with acquired immune deficiency syndrome. Trans Roy Soc Trop Med Hyg. 1989;83:844–6.

    Article  PubMed  CAS  Google Scholar 

  11. Howlett WP, Nkya WM, Mmuni KA, Missalek WR. Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. AIDS. 1989;3:289–96.

    Article  PubMed  CAS  Google Scholar 

  12. Perriens JH, Mussa M, Laubeya MK, et al. Neurological complications of HIV-1 seropositive internal medicine inpatients in Kinshasa, Zaire. J Acquir Immune Defic Syndr. 1992;5:333–40.

    PubMed  CAS  Google Scholar 

  13. Sebit MB. Neuropsychiatric HIV-1 infection study: in Kenya and Zaire cross-sectional phase I and II. Central Afr J Med. 1995;41(10):315–22.

    CAS  Google Scholar 

  14. Roberston KR, Nakasujja N, Wong M, et al. Pattern of neuropsychological performance among HIV positive patients in Uganda. BMC Neurol. 2007;7(8):1–7.

    Google Scholar 

  15. Salawu FK, Bwala SA, Wakil MA, et al. Cognitive function in HIV-seropositive Nigerians without AIDS. J Neurol Sci. 2008;267:142–6.

    Article  PubMed  Google Scholar 

  16. Njamnshi AK, Bissek AC, Ongolo-Zogo P, et al. Risk factors for HIV-associated neurocognitive disorders (HAND) in sub-Saharan Africa: the case of Yaounde-Cameroon. J Neurol Sci. 2009;285(1–2):149–53.

    Article  PubMed  CAS  Google Scholar 

  17. Wong MH, Roberston KR, Nakasujja N, et al. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Sahara Africa. Neurology. 2007;68:350–5.

    Article  PubMed  CAS  Google Scholar 

  18. Sacktor NC, Wong M, Nakasujja N, et al. The international HIV dementia scale: a new rapid screening test for HIV dementia. AIDS. 2005;19(13):1367–74.

    PubMed  Google Scholar 

  19. Kanmogne GD, Kuate CT, Cysique LA, et al. HIV-associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon. BMC Neurol. 2010;10:60.

    Article  PubMed  Google Scholar 

  20. Clifford DB, Mitike MT, Mekonnen Y, et al. Neurological evaluation of untreated human immunodeficiency virus infected adults in Ethiopia. J Neurovirol. 2007;13(1):67–72.

    Article  PubMed  Google Scholar 

  21. Lawler K, Mosepele M, Ratcliffe S, et al. Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study. J Int AIDS Soc. 2010;13:15.

    Article  PubMed  Google Scholar 

  22. 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 

  23. 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.

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. Power C, Selnes OA, Grim JA, McArthur JC. HIV dementia scale: a rapid screening test. J Acquir Immune Defic Syndr Human Retrovirol. 1995;8(3):273–8.

    Article  CAS  Google Scholar 

  26. Central Statistical Office, Zambia Demographic and Health Survey 2007, Ministry of Health (MOH) TDRCT, University of Zambia, and Macro International Inc. Calverton, Maryland, USA: CSO and Macro International Inc; 2009.

  27. Stringer JS, Zulu I, Levy J, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA. 2006;296(7):782–93.

    Article  PubMed  CAS  Google Scholar 

  28. Heaton RK, Clifford DB, Franklin DR Jr, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology. 2010;75(23):2087–96.

    Article  PubMed  Google Scholar 

  29. Sattler J. Assessment for children. 3rd ed. In: Sattler J, editor. San Diego, CA: Publisher Inc.; 1982.

  30. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state examination by age and educational level. JAMA. 1993;269(18):2386–91.

    Article  PubMed  CAS  Google Scholar 

  31. Mungas D. In-office mental status testing: a practical guide. Geriatrics. 1991; 46(7):54–8, 63, 66.

    Google Scholar 

  32. Maj M, Elia’D L, Satz P, et al. Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. Arch Clin Neuropsychol. 1993;8:123–35.

    PubMed  CAS  Google Scholar 

  33. Maj M, Satz P, Janssen R, et al. WHO neuropsychiatric AIDS study, cross-sectional phase II. Arch Gen Psychiatry. 1994;51:51–61.

    PubMed  CAS  Google Scholar 

  34. Roberston KR, Parsons TD, Sidtis J, et al. Time gait test: normative data for the assessment of the AIDS dementia complex. J Clin Exp Neuropsychol. 2006;28:1053–64.

    Article  Google Scholar 

  35. World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Available at: www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf. (2007). Accessed 30 March 2009.

  36. Selnes OA, Galai N, Bacellar H, et al. Cognitive performance after progression to AIDS: a longitudinal study from the Multicenter AIDS Cohort Study. Neurology. 1995;45(2):267–75.

    PubMed  CAS  Google Scholar 

  37. Bouwman FH, Skolasky RL, Hes D, et al. Variable progression of HIV-associated dementia. Neurology. 1998;50(6):1814–20.

    PubMed  CAS  Google Scholar 

  38. Chiesi A, Seeber AC, Dally LG, et al. AIDS dementia complex in the Italian National AIDS Registry: temporal trends (1987–93) and differential incidence according to mode of transmission of HIV-1 infection. J Neurol Sci. 1996;144(1–2):107–13.

    Article  PubMed  CAS  Google Scholar 

  39. Everall I, Vaida F, Khanlou N, et al. Cliniconeuropathologic correlates of human immunodeficiency virus in the era of antiretroviral therapy. J Neurovirol. 2009;15(5–6):360–70.

    Article  PubMed  CAS  Google Scholar 

  40. Roberston KR, Kapoor C, Robertson WT, et al. No gender differences in the progression of nervous system disease in HIV infection. J Acquir Immune Defic Syndr. 2004;36(3):817–22.

    Article  Google Scholar 

  41. Sacktor N, McDermott MP, Marder K, 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 

  42. Cole MA, Margolick JB, Cox C, et al. Longitudinally preserved psychomotor performance in long-term asymptomatic HIV-infected individuals. Neurology. 2007;69(24):2213–20.

    Article  PubMed  CAS  Google Scholar 

  43. Central Statistical Office. Zambia Demographic and Health Survey 2001–2002. In: Central Board of Health (CBOH), ORC Macro. Calverton, Maryland: Central Statistical Office, Central Board of Health, and ORC Macro; 2003.

Download references

Acknowledgments

This study was supported in part by the NIH PHS grants R21MH080612-01, the Ruth L. Kirschstein National Research Service Award 1 T32 AIO60547, and the Fogarty International TW001429 to CW. AH was a Ruth L. Kirschstein fellow and supported by Fogarty D43TW001429-09S1; MB, CM and VCM were Fogarty Fellows. We thank Margaret Hamakala, Mary Mainza (neuropsychological examiners), and the clients for their participation in this study. We thank Dr. Esteban Gonzalez Diaz for translating the abstract to Spanish. A gracious thank you to the reviewers for their insightful and helpful suggestions.

Author information

Authors and Affiliations

  1. Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Rm 102C, Morrison Center, 4240 Fair St, Lincoln, NE, 68583-0900, USA

    Adelina Holguin, Costantine Malama & Charles Wood

  2. Mailman Center for Child Development, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine, Miami, FL, 33136, USA

    Elizabeth J. Willen

  3. University Teaching Hospital, 10101, Lusaka, Zambia

    Mwanza Banda, Kaseya O. Chiyenu & Victor C. Mudenda

Authors
  1. Adelina Holguin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mwanza Banda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth J. Willen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Costantine Malama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaseya O. Chiyenu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victor C. Mudenda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Wood.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holguin, A., Banda, M., Willen, E.J. et al. HIV-1 Effects on Neuropsychological Performance in a Resource-Limited Country, Zambia. AIDS Behav 15, 1895–1901 (2011). https://doi.org/10.1007/s10461-011-9988-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-9988-9

Keywords

Search

Navigation