HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study.

Jade C Mogambery,Anand Moodley,Douglas Wilson,Halima Dawood

doi:10.4102/sajhivmed.v18i1.732

Abstract

IntroductionHIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings.ObjectivesThis prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal. Factors associated with HAND were examined, alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score and an association between HAND and non-adherence to antiretroviral therapy (ART) was explored.MethodsBetween May 2014 and May 2015, 146 ART-naïve outpatients were assessed for HAND. IHDS score ≤ 10 established a diagnosis of HAND. Functional capacity was assessed using Eastern Cooperative Oncology Group (ECOG) score. Chi-squared test was used to identify risk factors for HAND. The get-up-and-go test (GUGT) and Center for Epidemiological Studies Depression scale – revised (CESD-r) were tested against the IHDS. HIV viral load done six months after initiating ART was used as a surrogate marker for adherence to ART.ResultsThe prevalence of HAND was 53%. In total, 99.9% of patients with HAND had no functional impairment. Age > 50 years old was associated with HAND (p = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence (p = 0.06).ConclusionsWhile the prevalence of HAND is high, it is not associated with functional impairment which suggests that asymptomatic neurocognitive impairment is prevalent. Age > 50 years old is a risk factor for HAND. The GUGT and CESD-r are not useful diagnostic tools for HAND. The relationship between HAND and non-adherence should be further explored.

Highlights

Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system
The first mechanism is by cytokine release from astrocytes in response to infection of the central nervous system (CNS) by HIV.[1,2]
Patients with asymptomatic neurocognitive impairment (ANI) may progress to symptomatic forms of HIV-associated neurocognitive disorder (HAND) if HIV treatment is not commenced.[9]

Summary

Introduction

HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is a consequence of the invasion of HIV into the central nervous system (CNS).[1,2,3,4,5,6] The proposed pathogenesis involves two mechanisms of neuronal apoptosis.[1,2,3,7] The first mechanism is by cytokine release from astrocytes in response to infection of the CNS by HIV.[1,2] The second mechanism involves direct neural damage by HIV proteins.[1,2] The symptoms of HAND may be subtle or overt and encompass a spectrum of clinical presentations: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD).[2,6,8] Patients with ANI may progress to symptomatic forms of HAND if HIV treatment is not commenced.[9]

Objectives

Methods

Results

Conclusion