#3029 HIV-associated neurocognitive disorder: an investigation using structural neuroimaging in a c-ART treated tanzanian cohort

BackgroundThere is a newly emergent ageing population of people living with HIV (PLWH) in Africa. However, there is little research into HIV-associated neurocognitive disorder (HAND) in this population. Existing research suggests HAND is prevalent however the aetiology remains unclear. This study aims to determine whether HAND is truly prevalent and explore potential causes in PLWH on c-ART using objective structural measures.AimsExplore whether substantial atrophy and/or white matter hyperintensities (WMH) is present on the clinical magnetic resonance imaging (MRI) reports and quantitative analysis of people with optimally managed HIV in Northern Tanzania.Explore the aetiology of HAND by assessing whether cerebral atrophy and/or WMH is associated with demographic risk factors, HIV–related factors and/or comorbidities.Investigate whether structural damage is related to objectively measured cognitive impairment, and whether this is a subcortical or cortical impairment.Explore which neurocognitive test is the best predictor of structural damage and therefore most valid diagnostic test for HAND.MethodsA systematic sample of PLWH aged ≥ 50 were recruited from a HIV clinic in Kilimanjaro, Tanzania. Demographic data and comorbidities were self-reported. HIV-disease management data were obtained. Viral load and CD4 count were measured. A neurocognitive battery and informant history of functional impairment identified HAND. Cerebral atrophy (brain and ventricle volume) and WMH were measured using quantitative analysis of 1.5T MRI.Preliminary resultsThis cohort (n=91) had well-managed HIV (75.9% suppressed viral load, median CD4 507 cells/ul). The significant independent predictor (IP) of decreased brain volume was older age at HIV diagnosis (p=.001), and of increased ventricle volume was increased age (p<.0001), male gender (p<.0001) and increased frailty (p<.0001). The significant IPs of increased WMH volume were increased age (p<.0001) and smoking (p=.021). Only memory impairment independently predicted all structural measures.ConclusionsThis is the first MRI study of older c-ART treated PLWH in Africa. Despite c-ART and good disease management, HAND was objectively prevalent and unrelated to measures of HIV. Cerebral atrophy and WMH were associated with factors of neurodegeneration. Cerebral atrophy was associated with male gender and age at diagnosis (legacy effect).

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HIV-associated neurocognitive disorder and HIV-associated myelopathy in a patient with a preserved CD4, but high viral load-a rarely reported phenomenon: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-020-05297-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Biniyam Alemayehu Ayele ◽

Wondwossen Amogne ◽

Lalise Gemechu

Keyword(s):

Case Report ◽

Viral Load ◽

Literature Review ◽

High Viral Load ◽

Neurocognitive Disorder ◽

Hiv Associated Neurocognitive Disorder

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Prevalence of HIV-Associated Neurocognitive Disorder (HAND) among Patients Attending a Tertiary Health Facility in Northern Nigeria

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957414553839 ◽

2016 ◽

Vol 16 (1) ◽

pp. 48-55 ◽

Cited By ~ 22

Author(s):

Abdulkareem Jika Yusuf ◽

Abdulaziz Hassan ◽

Aisha Indo Mamman ◽

Haruna Mohammed Muktar ◽

Aishatu Maude Suleiman ◽

...

Keyword(s):

Viral Load ◽

Health Facility ◽

Depression Scale ◽

Cd4 Count ◽

Word Recall ◽

Hiv Positive ◽

Neurocognitive Disorder ◽

Cross Sectional ◽

Cognitive Complaint ◽

Hiv Associated Neurocognitive Disorder

Background: HIV-associated neurocognitive disorder (HAND) is a great source of morbidity in sub-Saharan African region. However, the magnitude of this problem remains largely uninvestigated despite having the largest number of population with HIV/AIDS. The aim of this study is to determine the prevalence of HAND among patients attending a tertiary health facility in Nigeria. Method: We conducted a cross-sectional study among HIV-positive patients on antiretroviral therapy (ART) for at least 1 year. They were assessed using the International HIV Dementia Scale, Word Recall Test, Stick Design Test, Subjective Cognitive Complaint Questionnaire, Alcohol Use Disorder Identification Test, Drug Abuse Screening Test, Center for Epidemiological Study–Depression Scale, Instrumental Activity of Daily Living, and neurological examination. The CD4 count and viral load were determined for all the participants. A consensus diagnosis was made on each case based on the Frascati criteria. Data obtained were analyzed using “SPSS” for Windows version 15. Results: A total of 418 HIV-positive patients participated in the study, of which 325 (77.8%) are females. The mean age (standard deviation) of the participants was 37.2 (9.3) years. The prevalence of HAND was 21.5% (95% confidence interval [CI] = 17.6%-25.4%), of which 9.6% were asymptomatic. The significant predictors of HAND in this study are duration of illness (odds ratio [OR] = 1.33 P < .001), detectable viral load (OR = 0.19, P < .001), CD4 count (OR = 0.99, P < .001), education (OR = 0.94, P = .011), stopping medication (OR = 3.55 P = .01), and severity of illness (OR = 1.24, P = .005). Conclusion: One-fifth of the HIV-positive patients in this study had HAND. Various sociodemographic and clinical features were related to the prevalence of HAND.

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Can Individualized-Targeted Computerized Cognitive Training Benefit Adults with HIV-Associated Neurocognitive Disorder? The Training on Purpose Study (TOPS)

AIDS and Behavior ◽

10.1007/s10461-021-03230-y ◽

2021 ◽

Author(s):

David E. Vance ◽

Pariya L. Fazeli ◽

Andres Azuero ◽

Virginia G. Wadley ◽

James L. Raper ◽

...

Keyword(s):

Cognitive Training ◽

Neurocognitive Disorder ◽

Computerized Cognitive Training ◽

Hiv Associated Neurocognitive Disorder

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Scaling Up Information Sharing on HIV-Associated Neurocognitive Disorder: Raising Awareness and Knowledge Among Key Stakeholders

SAGE Open ◽

10.1177/21582440211016898 ◽

2021 ◽

Vol 11 (2) ◽

pp. 215824402110168

Author(s):

Renato M. Liboro ◽

Paul A. Shuper ◽

Lori E. Ross

Keyword(s):

Health Care ◽

Information Sharing ◽

Service Providers ◽

Scale Up ◽

People Living With Hiv ◽

Neurocognitive Disorder ◽

Public Health Informatics ◽

Raising Awareness ◽

Hiv Associated Neurocognitive Disorder ◽

Hiv Aids

Although the majority of specialists and researchers in the field of HIV/AIDS are aware and knowledgeable about HIV-associated neurocognitive disorder (HAND) as a condition that affects as much as 50% of people living with HIV/AIDS (PLWH), research has documented that many health care and service providers who work directly with PLWH are either unaware of HAND or believe they do not know enough information about HAND to effectively support their clients experiencing neurocognitive challenges. Based on the findings of a qualitative study that interviewed 33 health care and service providers in HIV/AIDS services to identify and examine their awareness and knowledge on HAND, this article argues for utilizing a combination of Public Health Informatics principles; communication techniques, propagation strategies, and recognized approaches from Implementation and Dissemination Science; and social media and online discussion platforms, in addition to traditional Knowledge Mobilization strategies, to scale up information sharing on HAND among all relevant stakeholders. Increasing information sharing among stakeholders would be an important step to raising awareness and knowledge on HAND, and consequently, improving care, services, and support for PLWH and neurocognitive issues.

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Genetic variation of matrix metalloproteinase enzyme in HIV-associated neurocognitive disorder

Gene ◽

10.1016/j.gene.2019.02.057 ◽

2019 ◽

Vol 698 ◽

pp. 41-49 ◽

Cited By ~ 1

Author(s):

HariOm Singh ◽

Sumitra Nain ◽

Asha Krishnaraj ◽

Sonam Lata ◽

T.N. Dhole

Keyword(s):

Genetic Variation ◽

Matrix Metalloproteinase ◽

Neurocognitive Disorder ◽

Hiv Associated Neurocognitive Disorder

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Effects of a 12-week aerobic exercise programme on HIV-associated neurocognitive disorder in Nigeria: A protocol for randomized controlled trial (Preprint)

10.2196/preprints.29230 ◽

2021 ◽

Author(s):

Martins Nweke ◽

Nombeko Mshunqane ◽

Nalini Govender ◽

Aderonke Akineplu ◽

Adesola Oginniyi

Keyword(s):

Aerobic Exercise ◽

Repeated Measures ◽

Controlled Trial ◽

Exercise Programme ◽

Moderate Intensity ◽

Behavioural Intervention ◽

Neurocognitive Disorder ◽

Neurocognitive Performance ◽

Southeastern Nigeria ◽

Hiv Associated Neurocognitive Disorder

BACKGROUND The introduction of antiretroviral therapy (ART) has led to a drastic fall in the incidence of HIV-associated dementia. However, less severe but limiting forms of HIV-associated neurocognitive disorder (HAND) continues to be prevalent even with the use of ART. Aerobic exercise, a behavioural intervention may be a beneficial and effective complement to ART in the management of HAND. In HIV-negative individuals, aerobic exercise mitigates pathogenic changes similar to those of HAND. OBJECTIVE This protocol describes a randomized clinical trial designed to determine the effect of a 12-week aerobic exercise programme on HAND in Southeastern Nigeria. METHODS A minimum of seventy-six patients diagnosed with HAND will be randomized into aerobic exercise and control groups. Aerobic exercise will be carried out on a stationary bicycle ergometer at moderate intensity, three times a week for 12-weeks. Primary outcomes are neurocognitive performance, CD4-count and viral load. Evaluation of post-exercise neurocognitive performance will be undertaken using reliable neuropsychological tests relevant to PLWHIV, in line with Frascati criteria. Secondary outcomes such as quality of life, and activity limitation and social participation will be assessed using the WHOQOL-Bref, and the Oxford Participation and Activities questionnaire respectively. Data will be subjected to exploratory statistics to test for normality and homogeneity. The effect of the exercise programme on HAND will be analysed using two-way repeated-measures ANOVA, with Bonferroni’s correction. Within-group comparison will be undertaken using paired sampled t-test. RESULTS Enrollment began on 18th January 2021. Recruitment has been completed. The trial is ongoing and will be completed in July 2021 CONCLUSIONS The study will provide valuable information about the effect of aerobic exercise on HAND thus verifying the suitability of aerobic exercise as a complementary therapy for mitigating neurocognitive disorder among PLWHIV. Data from the study will be useful in pursuit of debate on the necessity of a sponsored rehabilitation arm in ART clinics. CLINICALTRIAL The study was registered with the PAN African Trial Registry (PACTR) on the 1stth September 2020. The registration ID is PACTR202009483415745.

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