Abstract
BackgroundWith the advent of modern era of combination antiretroviral therapy (cART) and increased longevity of people living with human immunodeficiency virus (PLHIV), human immunodeficiency virus-associated neurocognitive disorder (HAND) is commonly observed. This study explores the prevalence of HAND and the demographic and treatment variables in people with HAND, in Central India.Research methodologyPLHIV on cART visiting HIV clinic underwent screening for substance abuse using CAGE-AID, and depression using PHQ-2 followed by PHQ-9. The screening rules out overt conditions which might interfere with cognitive abilities of the individual and thereby act as confounding factor. Thus, a sample population of 96 was obtained, on whom International HIV Dementia Scale (IHDS) was applied to screen for dementia. Out of 96, 16 individuals detected to suffer from HAND. Quality of Life was assessed by Patient’s Assessment of Own Functioning Inventory (PAOFI).ResultsPrevalence of HAND was estimated to be 16/96 (16.66%). It was more common amongst unmarried individuals (p < 0.001) and lower educational status (p < 0.01) among social variables; while shorter duration of ART (<3 years) (p < 0.01) and lower CD4 nadir (≤200 cell/mm3; p<0.01) showed significant correlation among clinical variables. PAOFI revealed significant association between HAND and quality of life (p-value < 0.01, CI = 95%). Modified Mental State Examination (3MS), which determines cognitive ability in various domains based on tasks, was mostly affected for - similarities and read and obey (for 43.75% population).ConclusionSocial and clinical variables play a significant role in development of HAND. Routine screening for HAND in PLHIV will help in early identification and management of the disease. The quality of life for those suffering from the burden of HIV and HAND can be significantly improved if approached and treated early in the course of the disease.
Highlights
The pandemic of the human immunodeficiency virus (HIV), first recognised in 1981, has engulfed the entire planet in less than four decades
Prevalence of human immunodeficiency virus-associated neurocognitive disorder (HAND) was estimated to be 16/96 (16.66%). It was more common amongst unmarried individuals (p < 0.001) and lower educational status (p < 0.01) among social variables; while shorter duration of ART (
It ranges from asymptomatic neurocognitive impairment (ANI) - where the patient has no deficits on neurocognitive tests or with activities of daily living (ADL) or instrumental activity of daily living (IADL), to HIV-associated dementia (HAD) which is a severe form of HAND, causing significant difficulties in performing tasks of daily living [2]
Summary
The pandemic of the human immunodeficiency virus (HIV), first recognised in 1981, has engulfed the entire planet in less than four decades. One of the major complications of HIV observed in chronic cases is HIVassociated neurocognitive disorder (HAND). HAND includes a spectrum of neurocognitive changes, involving personality, motor, and cognitive changes. It ranges from asymptomatic neurocognitive impairment (ANI) - where the patient has no deficits on neurocognitive tests or with activities of daily living (ADL) or instrumental activity of daily living (IADL), to HIV-associated dementia (HAD) which is a severe form of HAND, causing significant difficulties in performing tasks of daily living [2]. With the advent of modern era of combination antiretroviral therapy (cART) and increased longevity of people living with human immunodeficiency virus (PLHIV), human immunodeficiency virus-associated neurocognitive disorder (HAND) is commonly observed. This study explores the prevalence of HAND and the demographic and treatment variables in people with HAND, in Central India
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