NeuroAIDS in Africa

Abstract

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting “NeuroAIDS in Africa.” This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.

NeuroAIDS in sub-Saharan Africa: A clinical review

“…Participants also presented findings on NeuroAIDS research and clinical care in Botswana, Cameroon, Ethiopia, Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. [30] The future looks promising for NeuroAIDS care and research in sub-Saharan Africa. At present, researchers in Africa are studying several clinical end-points in HAND, often in collaboration with investigators in the United States and other countries.…”

“…Since 2004, a series of meetings on "NeuroAIDS in Africa" were organized and funded by the US National Institute of Mental Health under the auspices of the International AIDS Society. [30,102,103] At the third meeting held in 2009 in Cape Town, South Africa, clinicians and researchers discussed the challenges and opportunities in NeuroAIDS care and research in sub-Saharan Africa. [30] Participants revealed data showing decreasing HIV prevalence and improved access to antiretroviral drugs in many nations of Africa.…”

“…[30,102,103] At the third meeting held in 2009 in Cape Town, South Africa, clinicians and researchers discussed the challenges and opportunities in NeuroAIDS care and research in sub-Saharan Africa. [30] Participants revealed data showing decreasing HIV prevalence and improved access to antiretroviral drugs in many nations of Africa. Factors responsible include better funding for HIV care by African governments and the Global Fund, the US president's emergency plan for AIDS relief (PEPFAR) and the roles of donor agencies and nongovernmental organizations.…”

“…[26] Currently, HAND is prevalent in 15-42% of HAART-treated patients in western countries. [27,28] In Africa, where access to HAART is limited and the clinical picture may be confounded by CNS-OIs, prevalence ranges between 21% in Cameroon, [29] 33% in Zambia, [30] and 53% in Nigeria. [14] Other potential confounders in HAND include disease stage of the study population and presence of comorbid conditions such as chronic hepatitis C virus infection, [31] methamphetamine use, anemia, and depression.…”

Neurotechnology and Psychiatric Biomarkers

“…Although the antiretroviral therapy reduced HIV symptoms, the cognitive deficits were not improved (Puthanakit et al, 2010). These clinical observations inform the need to obtain a better understanding of how and when HIV affects cognitive function and to develop novel therapeutic drug candidates to prevent or interfere with progression of HIV associated neurocognitive impairment (Robertson et al, 2010). Some treatments for the primary or secondary infections, may be more harmful to vulnerable brain tissue in children that have been compromised by HIV infection than in adults (LLorente et al, 2009).…”