Abstract
Background: The HIV associated mortality is decreasing in most countries due to the widespread use of antiretroviral therapy. However, HIV-associated neurocognitive disorder (HAND) remains a problematic issue that lowers the quality of life and increases the public health burden among people living with HIV. The prevalence of HAND varies across studies and selected samples. Therefore, we aimed to quantitatively summarize the pooled prevalence of Frascati-criteria-based HAND and to explore the potential demographic, clinical, and immunological factors.Methods: A comprehensive literature search in PubMed/Medline, Web of Science, Embase, and PsycINFO was performed. A random-effects meta-analysis was conducted using the event rate (ER) for the estimation of the incidence of HAND. Subgroup meta-analyses were used to evaluate between-group differences in categorical variables. Meta-regression with the unrestricted maximum likelihood (ML) method was used to evaluate associations of continuous variables.Results: Eighteen studies whose sample sizes ranged from 206 to 1555 were included in the final analyses. The estimated prevalence of HAND, ANI, MND and HAD were 44.9% (95% CI 37.4–52.7%), 26.2% (95% CI 20.7–32.7%), 8.5% (95% CI 5.6–12.7%), 2.1% (95% CI 1.2–3.7%), respectively. Factors associated with HAND were percent female, current CD4 count, education level and country development level (all ps < 0.05).Conclusion: Longitudinal cohort and multimodal neuroimaging studies are needed to verify the clinical prognosis and the underlying neurocognitive mechanism of HAND. In addition, it is urgently necessary to establish a standardized HAND diagnostic process.
Highlights
According to a report from the World Health Organization (WHO), the number of people living with HIV (PLWH) around the world rose to approximately 37.9 million at the end of 2019
We identified 19 eligible studies in this review, whose sample size ranged from 206 to 1,555
The results revealed significant heterogeneity across studies [Q(15) = 637.66, p < 0.001, I2 = 97.64%]. In this first meta-analysis of HIV-associated neurocognitive disorder (HAND), we found that the estimated prevalence was 43.9%
Summary
According to a report from the World Health Organization (WHO), the number of people living with HIV (PLWH) around the world rose to approximately 37.9 million at the end of 2019. PLWH were systematically evaluated by [1] cognitive tasks in verbal/language, attention/working memory, abstraction/executive, memory, processing speed, sensory-perceptual, and motor skills, [2] everyday functioning, [3] other pre-existing conditions that related to cognitive function (such as major depression and substance use) [4]. These criteria did not specify what psychological instruments should be used in HAND assessment, which leads to large heterogeneity in the adopted battery [5, 6]. We aimed to quantitatively summarize the pooled prevalence of Frascati-criteria-based HAND and to explore the potential demographic, clinical, and immunological factors
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