Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study.
BACKGROUND
The primary objective of this study was to determine the prevalence of neurocognitive impairment among HIV-positive individuals in Botswana, using the International HIV Dementia Scale (IHDS). We also compared performance on the IHDS with performance on tests of verbal learning/memory and processing speed, and investigated the association between performance on the IHDS and such variables as depression, age, level of education and CD4 count.


METHODS
We conducted a cross-sectional study of 120 HIV-positive individuals randomly selected from an outpatient HIV clinic in Gaborone, Botswana. Patients provided a detailed clinical history and underwent neuropsychological testing; measures of depression, daily activities and subjective cognitive complaints were recorded.


RESULTS
Despite the fact that 97.5% of subjects were receiving highly active antiretroviral therapy (HAART), 38% met criteria for dementia on the IHDS, and 24% were diagnosed with major depressive disorder. There was a significant association between neurocognitive impairment as measured by the IHDS and performance on the other two cognitive measures of verbal learning/memory and processing speed. Level of education significantly affected performance on all three cognitive measures, and age affected processing speed and performance on the IHDS. Depression and current CD4 count did not affect performance on any of the cognitive measures.


CONCLUSIONS
The prevalence of neurocognitive impairment in HIV-positive individuals in Botswana is higher than expected, especially since almost all of the subjects in this study were prescribed HAART. This suggests the need to reconsider the timing of introduction of antiretroviral therapy in developing countries where HAART is generally not administered until the CD4 cell count has dropped to 200/mm3 or below. The contribution of other factors should also be considered, such as poor central nervous system penetration of some antiretrovirals, drug resistance, potential neurotoxicity, and co-morbidities. Memory impairment and poor judgment may be underlying causes for behaviours that contribute to the spread of HIV and to poor adherence. It is important to identify these neurobehavioural complications of HIV so that effective treatments can be developed.
Lawler
Kathy
K
Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Mosepele
Mosepele
M
Infectious Disease Care Center, Princess Marina Hospital, Gaborone, Botswana.
Ratcliffe
Sarah
S
Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Seloilwe
Esther
E
Centre for the Study of HIV and AIDS, University of Botswana, Gaborone, Botswana.
Steele
Katherine
K
Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
Nthobatsang
Rudo
R
Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
Steenhoff
Andrew
A
Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Children's Hospital of Philadelphia, Philadelphia, PA, USA.
D015526:AIDS Dementia Complex; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001902:Botswana / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000523:psychology; D006801:Humans; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D010865:Pilot Projects; D055815:Young Adult
D019380:Anti-HIV Agents
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