Abstract
Successful treatment of HIV with anti-retroviral therapy (ART) is resulting in more people living with HIV-associated neurocognitive disorder (HAND). In sub-Saharan Africa, this calls for strategic planning and judicious allocation of scarce resources, which requires an accurate estimate of the prevalence of HAND. Estimates of the prevalence of HAND in sub-Saharan Africa vary greatly, between 18.8% and 88.3%. This variability may be explained by factors such as different diagnostic approach, neuromedical examination, ART status, sampling method, substance abuse, assessors’ qualification, depression and outcome measure. Different methods of diagnosing HAND, different outcome measures and non-random sampling techniques make it almost impossible to accurately estimate the prevalence of HAND in sub- Saharan Africa, often resulting in overestimation of the burden of disease. Consumers of health research should consider certain study characteristics and exercise appropriate caution when interpreting burden of disease in sub-Saharan Africa, especially when pursuing policy shift. Underestimating the prevalence of HAND will certainly affect the capacity and speed of containment, while overestimating will draw unnecessary attention and result in the misallocation of scarce resources. Significance: The high prevalence of HAND in sub-Saharan Africa as estimated in this review calls for further research on the impact of HAND on activities of daily living and putative therapeutic modalities. We highlight which study characteristics should be critically checked when using prevalence estimates for the purpose of health policy and distribution of scarce resources in sub-Saharan Africa. By favouring certain factors, this review will guide HIV health researchers in which techniques should be used to estimate the burden of HAND. These factors may also apply to estimating the burden of other diseases in sub-Saharan Africa.
Highlights
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is one of the most common neurological complications of HIV in the antiretroviral therapy (ART) era.[1]
Aside from our meta-analysis of HAND prevalence estimates, we explored the effect of different study characteristics such as diagnostic criteria, outcome measures, ART status and duration, assessors’ qualifications, assessment
This increase reflects the widespread use of ART in sub-Saharan Africa and indicates that asymptomatic and mild cognitive impairment are common amongst people living with HIV (PLWHIV)
Summary
Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is one of the most common neurological complications of HIV in the antiretroviral therapy (ART) era.[1] The growing burden of HAND justifies a quintessential global response to address this important mental health challenge among people living with HIV (PLWHIV).[2] Before ART was introduced in 1996, 20–30% of people with advanced HIV infection displayed symptoms of severe HAND3,4, with death occurring within 6 months[5]. The symptoms of HAND include behavioural and cognitive difficulties such as memory loss, poor attention and concentration span, acalculia, poor information processing and inadequate multitasking resulting in poor executive function.[17] Most PLWHIV contract the virus early in life, usually in their late thirties.[18] Long-term treatment and inability to work may have severe economic consequences for many families. Impaired neurocognitive function further predisposes PLWHIV to low productivity, job losses, restricted social participation and poverty.[19]
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