The Impact of Antiretroviral Therapy on Neurocognitive Outcomes Among People Living with HIV in Low- and Middle-Income Countries (LMICs): A Systematic Review

Michael, Henry Ukachukwu; Naidoo, Saloshni; Mensah, Kofi Boamah; Ramlall, Suvira; Oosthuizen, Frasia

doi:10.1007/s10461-020-03008-8

Cited by 16 publications

(10 citation statements)

References 111 publications

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“…Third, two research team members independently reviewed the full text of all 30 articles. An article was included in the final review if all the following criteria were met (1) studies conducted in LMICS; (2) studies that focused on self-screening or self-collection, and (3) studies that included women with HIV. Studies that enrolled 50% or more of women with HIV and used HIV-negative women as a comparison group were included in the final review.…”

Section: Data Screening and Inclusion Criteriamentioning

confidence: 99%

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HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

et al. 2022

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Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.

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Section: Data Screening and Inclusion Criteriamentioning

confidence: 99%

“…Globally, persons with HIV, including those in low- and middle-income countries (LMICs), are living longer due to the wide availability of combination antiretroviral therapy (cART) [ 1 , 2 , 3 , 4 ]. In 2020, over 37.7 million people worldwide were living with HIV (including 1.5 million with new infections) [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

et al. 2022

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“…In contrast, after the introduction of ART, the incidence of milder forms of HAND has been observed more frequently in patients with a normal or nearnormal CD4 cell count [3]. In sum, ART seems not to be sufficient to fully prevent or manage HAND [9].…”

Section: Despite Art Hand Can Still Occurmentioning

confidence: 97%

Neuropsychological Characteristics of Adults with HIV: A Systematic Review

CC¹,

Natalia²,

YT³

2021

J HIV AIDS

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“…However, we conducted a sensitivity analysis using r = 0.2 and r = 0.5 to investigate how the meta-analysis results varied (Borenstein et al, 2009). We anticipated significant statistical heterogeneity due to the high degree of methodological heterogeneity and differences in participants' characteristics across studies (Michael et al, 2020). Therefore, we pooled effect sizes using a random-effects model according to the Hartung-Knapp-Sidik-Jonkman method (Hartung & Knapp, 2001;Sidik & Jonkman, 2006).…”

Section: Overall Analysesmentioning

confidence: 99%

“…The global prevalence of HIV-associated neurocognitive impairment in the antiretroviral era is estimated at 43-45% (Wang et al, 2020;Wei et al, 2020). Varying prevalence rates have been reported in studies conducted in low-and middleincome countries in the range of 12-74% (Michael et al, 2020). While the debate on prevalence estimates of HAND based on the Frascati criteria lingers, it is reassuring that most cases of HIV-associated neurocognitive impairment are asymptomatic (Gisslen et al, 2011;Nightingale et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

et al. 2021

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HIV-associated neurocognitive impairment remains a challenge even in the era of antiretroviral therapy (ART). Over 90% of people living with HIV are in low-and middle-income countries. Hence, it is not surprising that such countries bear a considerable burden of comorbidities like HIV-associated neurocognitive impairment despite an overall increase in life expectancy. The literature suggests differences in patient characteristics, clinical profile, prevalent HIV subtypes, treatment choices, pharmacogenetics, and socioeconomic factors between low-and middle-income countries compared with highincome countries. Therefore, we aimed to evaluate the effect of ART on neurocognitive outcomes in low-and middle-income countries. A comprehensive search of five databases (PubMed, CINAHL, CENTRAL, PsychInfo, Google scholar) for studies published between 1996 to 2020 was performed to identify studies that reported neurocognitive outcomes in ART-treated and ART naïve HIV positive individuals. Two independent reviewers conducted study screening, data extraction, and evaluation of the risk of bias. Pooled effect size estimates (Hedges' g) and 95% CI were computed using random-effects models. Sensitivity analysis, subgroup analysis, meta-regression, and evaluation of publication bias were also conducted. Forty studies (24 cross-sectional, 13 longitudinal studies, and two randomized controlled trials) contributed to a series of meta-analyses. We found significant small to moderate effects of antiretroviral therapy for global cognition (Hedges' g observed = 0.30; 95% CI: 0.15, 0.44; k = 25; p = 0.0003; I 2 = 92.1%; tau = 0.32; Q = 305.1), executive function (Hedges' g = 0.24, 95%CI: 0.02,0.46; p-0.04; k = 8; I 2 = 37.5%; tau = 0.23; Q = 11.2), and speed of information processing (Hedges' g = 0.25, 95% CI: 0.05, 0.45; k = 9; p = 0.02; I 2 = 86.4%; tau = 0.21; Q = 58.9). We found no significant ART effect on attention-working memory, learning and memory, motor function, and verbal fluency. No significant effect was seen with the duration of therapy, efavirenz use, and Central Penetrating Effectiveness (CPE) of antiretroviral therapy. Subgroup analyses identified study design (betweengroup and within-group; cross-sectional and longitudinal) and normative scores as significant sources of heterogeneity. Metaregression analysis indicated that nadir CD4 modified the magnitude of ART's effect on cognitive outcomes. Age, gender, and country income-group were not significant moderators. Our findings provide systematic evidence that antiretroviral therapy improves neurocognitive outcomes in the domains of global cognition, executive function and speed of information processing, of people living with HIV in low-and middle-income countries, especially those with advanced immunosuppression. However, these findings are not definitive as they are limited by the probability of publication bias, high heterogeneity, and exclusion of significant confounders. Prospero registration number: CRD42020203791.

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The Impact of Antiretroviral Therapy on Neurocognitive Outcomes Among People Living with HIV in Low- and Middle-Income Countries (LMICs): A Systematic Review

Cited by 16 publications

References 111 publications

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

Neuropsychological Characteristics of Adults with HIV: A Systematic Review

A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

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