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

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.

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Global prevalence and burden of HIV-associated neurocognitive disorder

Neurology ◽

10.1212/wnl.0000000000010752 ◽

2020 ◽

Vol 95 (19) ◽

pp. e2610-e2621 ◽

Cited By ~ 1

Author(s):

Yunhe Wang ◽

Moxuan Liu ◽

Qingdong Lu ◽

Michael Farrell ◽

Julia M. Lappin ◽

...

Keyword(s):

Data Extraction ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Neurocognitive Disorder ◽

Cross Sectional ◽

Asymptomatic Neurocognitive Impairment ◽

Cd4 Cell Count ◽

Hiv Associated Neurocognitive Disorder ◽

Sub Saharan ◽

High Level

ObjectiveTo characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.MethodsWe searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.ResultsOf 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).ConclusionsOur findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

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HIV-ASSOCIATED NEUROCOGNITIVE DISORDER (HAND) PADA PASIEN DENGAN HIV TANPA INFEKSI OPORTUNISTIK

Callosum Neurology ◽

10.29342/cnj.v2i3.86 ◽

2019 ◽

Vol 2 (3) ◽

pp. 11-12

Author(s):

Dhyatmika Gde Putra ◽

Widyastuti Ketut ◽

Laksmidewi AAA. Putri

Keyword(s):

Learning Ability ◽

Fixed Dose ◽

Neurocognitive Disorder ◽

Asymptomatic Neurocognitive Impairment ◽

Clock Drawing Test ◽

Immunodeficiency Virus ◽

New Learning ◽

Dose Combination ◽

Hiv Associated Neurocognitive Disorder ◽

Trial Making Test

Latar Belakang: Infeksi Human Immunodeficiency Virus (HIV) telah menjadi epidemi di seluruh dunia termasuk di Indonesia. Salah satu komplikasi infeksi HIV pada sistem saraf pusat (SSP) berupa gangguan fungsi kognitif yang disebut HIV-associated neurocognitive disorder (HAND). Replikasi HIV dalam jangka waktu panjang terjadi pada astrosit dan mikroglia, yang dapat menurunkan fungsi neuronal. HAND terkait dengan aktivitas virus dan mediator inflamasi sel imun pada SSP sehingga menyebabkan kerusakan neuron otak. Kasus: Pasien perempuan, 28 tahun, suku Bali, mengeluh mudah lupa yang dialami sejak 2 tahun lalu. Pasien masih dapat melakukan aktivitas sehari-hari secara mandiri walaupun keluhan lupa terkadang dirasakan mengganggu. Pasien memiliki riwayat infeksi HIV sejak bulan September 2015 dengan CD4 16 sel/µl dan mendapat terapi ARV fixed-dose combination dengan regimen tenofovir, lamivudine, dan efavirenz. Pemeriksaan neurobehavior dijumpai atensi baik, gangguan memori terutama new learning ability, memori tunda, asosiasi berpasangan, gangguan visuospasial dan eksekutif, ADL dan IADL mandiri, MMSE: 24, MoCA Ina: 14, Clock Drawing Test: 3, Trial making test A baik, Trial making test B terganggu, International HIV Dementia Scale (IHDS): 10.5, Skala penilaian depresi Hamilton: 15. Hasil CT Scan kepala dalam batas normal. Diskusi: Dari hasil pemeriksaan, pasien dikategorikan dalam HAND tipe Asymptomatic Neurocognitive Impairment (ANI). Kadar CD4 diketahui berhubungan dengan derajat kerusakan neuron otak dan kadar CD4 nadir rendah (≤ 200 sel/µl) merupakan faktor risiko terjadinya gangguan kognitif pada pasien dengan HIV. Pemberian terapi kombinasi ARV dapat menunjukkan peningkatkan performa fungsi kognitif dan fungsional. Simpulan: Infeksi HIV secara langsung pada SSP dapat menyebabkan gangguan neurokognitif dan inisiasi pemberian terapi ARV dini merupakan usaha pencegahan terjadinya perburukan lebih lanjut.

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Natural Bioactives as a potential Therapeutic Modality against NeuroAIDS

Current Topics in Medicinal Chemistry ◽

10.2174/1568026621666210412152428 ◽

2021 ◽

Vol 21 ◽

Author(s):

Musheer Ahmed ◽

Ashif Iqubal ◽

Sanjula Baboota ◽

Javed Ali

Keyword(s):

Antiretroviral Therapy ◽

Ex Vivo ◽

Therapeutic Modality ◽

Neuroprotective Activity ◽

Neurocognitive Disorder ◽

Combination Antiretroviral Therapy ◽

Bioactive Constituents ◽

Asymptomatic Neurocognitive Impairment ◽

Therapy Regimen ◽

Hiv Associated Neurocognitive Disorder

: With the introduction of antiretroviral therapy, the worldwide AIDS-related deaths have decreased, and life expectancy has increased, so has the prevalence of AIDS-related neurological disorders or neuroAIDS. HIV associated neurocognitive disorder such as mild neurocognitive disorder and asymptomatic neurocognitive impairment have largely remained stable or increased among the HIV infected individuals in the combination antiretroviral therapy era and with the emerging evidence that antiretrovirals with high CNS penetration effectiveness score contribute to the neurotoxicity and HIV associated neurocognitive disorder. have ushered the search for natural, nontoxic bioactive constituents having pre-established neuroprotective, anti-inflammatory and restorative neurocognitive activity. In this review, we have highlighted the probable mechanism of neuroAIDS infection, the problem with the existing antiretroviral therapy, along with various bioactive constituents with in vivo, in vitro, or ex vivo evidence of their neuroprotective activity that can be used as an adjuvant with the current combination antiretroviral therapy regimen or can even serve as an alternate to the antiretrovirals for treatment of HIV associated neurocognitive disorder.

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The prevalence of depression and its correlates in ankylosing spondylitis: A systematic review and meta-analysis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.264 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S148-S149 ◽

Cited By ~ 1

Author(s):

C. Hopkins ◽

C. Moulton

Keyword(s):

Ankylosing Spondylitis ◽

Disease Activity ◽

Functional Impairment ◽

Meta Analysis ◽

Depression Scale ◽

Diagnostic Tools ◽

Depression Prevalence ◽

Prevalence Estimates ◽

Prevalence Of Depression ◽

Meta Regression

IntroductionAnkylosing spondylitis (AS) is a chronic inflammatory disease, associated with significant pain, functional impairment, and diminished quality of life. However, there is significant uncertainty regarding the prevalence of depression in AS and its associations.ObjectivesWe performed a meta-analysis to examine the prevalence of depression in AS and its associated correlates.MethodsThe study protocol was prospectively registered with PROSPERO (CRD42015019676). EMBASE, Medline, PsycINFO and Web of Science were systematically searched for cross-sectional studies with ≥ 50 adult AS patients, which reported depression prevalence using diagnostic criteria or a validated screening tool. Depression prevalence, tool and threshold used, age, gender, disease duration, as well as measures of disease activity, functional impairment, pain and innate inflammation, were abstracted. OpenMeta was used to calculate pooled prevalence estimates and to conduct meta-regression.ResultsEight hundred and seventy-seven texts were identified and 17 studies satisfied inclusion criteria, totalling 3187 participants (75.2% male). Six diagnostic tools and 10 different thresholds were reported, with depression prevalence estimates ranging from 4.9–55.5%. In studies using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), 37.1% of participants satisfied criteria for mild (≥ 8) and 8.2% met criteria for moderate depression (≥ 11). Multivariate meta-regression demonstrated significant positive correlations between depression and, respectively, disease activity (P < 0.001) and C-reactive protein (P < 0.001).ConclusionsThe prevalence of depression in AS is comparable with that of other rheumatic and degenerative diseases. Moreover, depression demonstrates significant associations with age, inflammation and disease activity, which require further investigation in prospective studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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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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HIV-Associated Neurocognitive Disorders

The Oxford Handbook of Adult Cognitive Disorders ◽

10.1093/oxfordhb/9780190664121.013.3 ◽

2019 ◽

pp. 27-60

Author(s):

Jennifer E. Iudicello ◽

Erin E. Morgan ◽

Mariam A. Hussain ◽

Caitlin Wei-Ming Watson ◽

Robert K. Heaton

Keyword(s):

Differential Diagnosis ◽

Neurocognitive Impairment ◽

Hiv Treatment ◽

People Living With Hiv ◽

Neurocognitive Disorder ◽

Diagnostic Systems ◽

Neurocognitive Performance ◽

Everyday Functioning ◽

Asymptomatic Neurocognitive Impairment ◽

Age Related

Human immunodeficiency virus enters the central nervous system (CNS) early after systemic infection, and may cause neural injury and associated neurocognitive impairment through multiple direct and indirect mechanisms. An international conference of multidisciplinary neuroAIDS experts convened in 2005 to propose operationalized research criteria for HIV-related cognitive and everyday functioning impairments. The resulting classification system, known as the Frascati criteria, defined three types of HIV-associated neurocognitive disorder (HAND): asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD). Consideration of comorbid conditions that can influence neurocognitive performance, such as developmental disabilities, non-HIV forms of CNS compromise (neurological and systemic), severe psychiatric conditions, and substance use disorders, is essential to differential diagnosis. Since the introduction of combination antiretroviral therapy (ART), rates of severe HAND (i.e., HAD) have greatly declined, although the milder forms of HAND remain quite prevalent, even in virally suppressed people living with HIV (PLWH). Beyond ART, clinical management of HAND includes behavioral interventions focused on neurocognitive and functional improvements. This chapter covers a range of HAND-related topics, such as the neuropathological mechanisms of HIV-related CNS injury, assessment and diagnostic systems for neurocognitive and everyday functioning impairment in HIV, treatment and protective factors, aging with HIV, HAND in international settings, and ongoing challenges and controversies in the field. Future needs for progress with HAND include advances in early detection of mild cognitive deficits and associated functional impairment in PLWH; biomarkers that may be sensitive to its underlying pathogenesis; and differential diagnosis of HAND versus age-related, non-HIV-associated disorders.

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Comorbidity, Functional Impairment, and Emotional Distress: A Coping Mediation Model for Persons With Cancer

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa122 ◽

2021 ◽

Author(s):

Thomas V Merluzzi ◽

Errol J Philip ◽

Brenna Gomer ◽

Carolyn A Heitzmann Ruhf ◽

Dahyeon Kim

Keyword(s):

Cancer Patients ◽

Emotional Distress ◽

Functional Impairment ◽

Model Comparison ◽

Depression Scale ◽

Life Assessment ◽

Functional Impairments ◽

Brief Cope ◽

Distress Scale ◽

The Relationship

Abstract Background Comorbid disease in cancer patients can substantially impact medical care, emotional distress, and mortality. However, there is a paucity of research on how coping may affect the relationship between comorbidity and emotional distress. Purpose The current study investigated whether the relations between comorbidity and emotional distress and between functional impairment and emotional distress were mediated by three types of coping: action planning (AP), support/advice seeking (SAS), and disengagement (DD). Methods Four hundred and eighty-three persons with cancer completed a measure of functional impairment (Sickness Impact Profile), the Checklist of Comorbid Conditions, the Brief COPE, the Hospital Anxiety and Depression Scale, the Quality of Life Assessment for Cancer Survivors (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were used to form a latent construct representing the outcome, emotional distress. Results Model comparison analysis indicated that the model with DD as a mediator had a better fit than models containing AP and SAS. DD mediated the relationship between functional impairment and emotional distress, so that engaging in DD was associated with greater distress. In addition, comorbidity and functional impairment were directly and positively related to emotional distress, but the relation between comorbidity and distress was not mediated by coping type. Conclusions Both comorbidity and functional impairment may be associated with distress, but disengagement coping only mediated the relation involving functional impairment and was positively associated with distress. Future studies can investigate whether teaching active coping or adaptive coping (e.g., through mindfulness exercises) can decrease distress in cancer patients, despite functional impairments.

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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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