HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study

• Main Authors: Jade C. Mogambery (Author), Halima Dawood (Author), Douglas Wilson (Author), Anand Moodley (Author)
• Format: Book
• Published: AOSIS, 2017-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1608-9693; 2078-6751; 10.4102/sajhivmed.v18i1.732
• Keywords: Public aspects of medicine; RA1-1270; Infectious and parasitic diseases; RC109-216
• Source: Southern African Journal of HIV Medicine, Vol 18, Iss 1, Pp e1-e5 (2017)

Introduction: HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings. Objectives: This prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal. Factors associated with HAND were examined, alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score and an association between HAND and non-adherence to antiretroviral therapy (ART) was explored. Methods: Between May 2014 and May 2015, 146 ART-naïve outpatients were assessed for HAND. IHDS score ≤ 10 established a diagnosis of HAND. Functional capacity was assessed using Eastern Cooperative Oncology Group (ECOG) score. Chi-squared test was used to identify risk factors for HAND. The get-up-and-go test (GUGT) and Center for Epidemiological Studies Depression scale - revised (CESD-r) were tested against the IHDS. HIV viral load done six months after initiating ART was used as a surrogate marker for adherence to ART. Results: The prevalence of HAND was 53%. In total, 99.9% of patients with HAND had no functional impairment. Age > 50 years old was associated with HAND (p = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence (p = 0.06). Conclusions: While the prevalence of HAND is high, it is not associated with functional impairment which suggests that asymptomatic neurocognitive impairment is prevalent. Age > 50 years old is a risk factor for HAND. The GUGT and CESD-r are not useful diagnostic tools for HAND. The relationship between HAND and non-adherence should be further explored.