Characterization of HIV-Associated Neurocognitive Disorders Among Individuals Starting Antiretroviral Therapy in South Africa

Abstract

HIV-Associated Neurocognitive Disorders (HAND) exert an impact on everyday functions, including adherence. The prevalence of and risk factors for HAND in patients commencing anti-retroviral therapy in Southern Africa are unknown. Participants from primary care clinics in Cape Town, South Africa underwent detailed neuropsychological, neuropsychiatric, and neuromedical evaluation. Using the updated American Academy of Neurology (AAN) criteria, participants were classified into categories of HAND, and demographic and clinical risk factors for HIV-dementia (HIV-D) were assessed. The prevalence of mild neurocognitive disorder (MND) and HIV-D were 42.4 and 25.4%, respectively. There were significant associations between lower levels of education and older age with HIV-D, and a trend to association with HIV-D and lower CD4 count. In a regression model, a lower level of education and male gender were predictive of HIV-D. These findings suggest that HAND are highly prevalent in primary care settings in South Africa where clade C HIV is predominant.

High prevalence of HIV-associated neurocognitive disorder in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China

“…Thus, whether such HIV-independent changes potentially affect MoCA scores is unclear and requires further study. In contrast to the current results, a study by Joska et al showed that being male rather than female was predictive of development of HIVassociated dementia (18). The disparity in findings can perhaps be explained by the fact that the female patients in the current study were significantly less educated than male patients.…”

“…In other studies, HAND is also reported to be more prevalent in patients who were older and who had lower levels of education (17,18). However, MoCA was not used to assess neurocognitive disorders in non-HIV infected controls matched by age and educational level in the current study.…”

Dementia in rural South Africa: A pressing need for epidemiological studies

“…[11] Prevalences are higher among people accessing HIV care in sub-Saharan African countries with a high HIV seroprevalence. Prevalences of 42% for HAND and 25% for HAD were reported among individuals starting HAART in primary care centres in Cape Town, [12] with all study participants being in later stages of HIV infection. Cognitive disorder in HIV is particularly important in view of associations with poor adherence to HAART, faster disease progression and mortality.…”

“…Cognitive disorder in HIV is particularly important in view of associations with poor adherence to HAART, faster disease progression and mortality. [12] It is difficult to quantify the impact of numbers of people with dementia and of the age distribution of dementia cases in the region. Given an adult HIV seroprevalence of 15 -25% in southern African countries, it is conceivable that most patients with dementia in the region are likely to have HAD.…”

Nursing Students' Intentions to Work in Dementia Care: Influence of Age, Ageism, and Perceived Barriers

“…Higher prevalences have been seen among people accessing HIV care in high HIV seroprevalence sub-Saharan African countries (e.g. 42% with HAND and 25% with HIV-associated dementia in those starting HAART in primary care centres in Cape Town, South Africa) (33). Cognitive disorder in HIV is particularly important in view of associations with poor adherence to HAART, faster disease progression, and mortality (34).…”