HIV-associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon

Abstract

BackgroundThe disease burden of human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS) is highest in sub-Saharan Africa but there are few studies on the associated neurocognitive disorders in this region. The objectives of this study were to determine whether Western neuropsychological (NP) methods are appropriate for use in Cameroon, and to evaluate cognitive function in a sample of HIV-infected adults.MethodsWe used a battery of 19 NP measures in a cross-sectional study with 44 HIV+ adults and 44 demographically matched HIV- controls, to explore the validity of these NP measures in Cameroon, and evaluate the effect of viral infection on seven cognitive ability domains.ResultsIn this pilot study, the global mean z-score on the NP battery showed worse overall cognition in the HIV+ individuals. Significantly lower performance was seen in the HIV+ sample on tests of executive function, speed of information processing, working memory, and psychomotor speed. HIV+ participants with AIDS performed worse than those with less advanced HIV disease.ConclusionsSimilar to findings in Western cohorts, our results in Cameroon suggest that HIV infection, particularly in advanced stages, is associated with worse performance on standardized, Western neurocognitive tests. The tests used here appear to be promising for studying NeuroAIDS in sub-Saharan Africa.

Neurocognitive deficits in HIV-infected women and victims of childhood trauma

“…Executive function disturbances are frequent among HIV patients (Grant, 2008). HIV-related deficits in executive functioning have been consistently reported in the both the developed world (Grant et al, 1987; Grant, 2008; Heaton et al, 2011; Richardson et al, 2002) and the developing world (Cysique et al, 2007; Kanmogne et al, 2010; Robertson et al, 2007; Sacktor et al, 2006; Yepthomi et al, 2006) but as previously mentioned, women have been under-represented in neurocognitive studies of HIV. Except for the present study, only two all-female studies to date have demonstrated impairments in abstraction using the Colour Trails Tests.…”

“…Memory disturbances in particular tend to be most prominent (Grant, 2008). HIV-related deficits in memory have been consistently reported in the both the developed world (Grant et al, 1987; Heaton et al, 1995; Heaton et al, 2011; Maki et al, 2009; Mason et al, 1998; Saykin et al, 1991; Tozzi et al, 2005) and the developing world (Cysique et al, 2007; Gupta et al, 2007; Kanmogne et al, 2010; Lawler et al, 2010; Robertson et al, 2007; Sacktor et al, 2006; Wong et al, 2004; Yepthomi et al, 2006). However, participant characteristics, methodological aspects, and instrumentation have varied widely among studies and women have been under-represented in these studies.…”

Long-term efavirenz use is associated with worse neurocognitive functioning in HIV-infected patients

“…The long-term effects of these drugs on NC functioning are of particular relevance both to the management of HIV disease and to overall public health in these settings with a high HIV prevalence. Highlighting the importance of the finding, several recent reports have identified the high prevalence and severity of HAND in Sub-Saharan African and Asian countries (Kanmogne et al 2010; Robertson et al 2012b; Sacktor et al 2006). The translation of our findings into practice should be proceeded with caution as the threshold of NC impairment warranting a regimen change remains to be determined.…”

Neurocognitive functioning among HIV-positive adults in southern India

“…We used the HNRP International NP battery, which has estimated prevalence of HAND in studies in Brazil 9 , Cameroon 8 , China 10 , India 11,12 , Nigeria 13 , South Africa, USA 14 , and Zambia 15 . Nurses were trained and certified to administer the battery.…”

“…This battery included 12 tests that yield 17 measures to evaluate multiple cognitive domains that are known to be vulnerable to HIV 6–8 .…”