Worldwide Prevalence of HIV Associated Neurocognitive Disorders (HAND) and its associated factors: A systematic review and meta- analysis

Abstract

Background: HIV associated neurocognitive disorders are common in people living with HIV/AIDS and affects adherence of patients to prescription, activities of daily living and quality of life of patients. However, there is a lack of summative evidence in the area. The present meta-analysis was therefore employed to address this gap. Methods: we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines during our electronic search in Psych-Info, EMBASE, Scopus and PubMed. The retrieved articles were stored with endnote reference manager and data was extracted using Meta-XL version 5.3. The quality of studies were evaluated with modified Newcastle–Ottawa Scale (NOS). A random-effect model and STATA-16 were used to compute the average estimate of HAND. Heterogeneity was weighed with I2 statistics. A sensitivity analysis and subgroup analysis were employed. The existence /nonexistence of a publication bias were checked with the eye ball test and eggers test of publication bias.Results: The average prevalence of HAND was 50.41% (95% CI: 45.56, 55.26). The average estimate of HAND in Europe was found to be 50.015% whereas in Africa, Asia and United States of America (USA) it was 49.566%, 52.032 %, 50.407% respectively. The prevalence of HAND in studies which used HIV Dementia Scale (IHDS) was 36.883% & 59.956% at a cutoff points of IHDS< 9.5 & IHDS <10 respectively. In addition the estimated average of HAND with the global dementia scale (GDS) was 40.766%. The prevalence of HAND in cross-sectional, cohort and case control studies was 49.52%, 54.087% and 44.45% in that order. Sociodemographic variables such as low level of education and older age, clinical and HIV related variables such as advanced stage of the illness and CD4 count of 500 cells/dl or less and psychological variables such as comorbidity of depression increases the risk of HAND.Conclusion: The average prevalence of HAND was high (more than half of participants) and factors such as low level of education, older age, advanced stage of the illness and comorbidity of depression increases the risk of HAND. Public health interventions to HIV patients should target these essential problems.