title: Neurocognitive impairment among HIV-positive individuals in Botswana: a pilot study.
abstract: 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.
authors.affiliation: Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lawler
authors.affiliation: Infectious Disease Care Center, Princess Marina Hospital, Gaborone, Botswana.
authors.forename: Mosepele
authors.initials: M
authors.lastname: Mosepele
authors.affiliation: Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ratcliffe
authors.affiliation: Centre for the Study of HIV and AIDS, University of Botswana, Gaborone, Botswana.
authors.forename: Esther
authors.initials: E
authors.lastname: Seloilwe
authors.affiliation: Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Steele
authors.affiliation: Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rudo
authors.initials: R
authors.lastname: Nthobatsang
authors.affiliation: Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.|Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Steenhoff
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents
references.citation: Am J Psychiatry. 1994 Feb;151(2):233-6
references.pmid: 8296895
references.citation: AIDS Care. 2006 Nov;18(8):911-7
references.pmid: 17012080
references.citation: J Clin Exp Neuropsychol. 2008 Apr;30(3):338-48
references.pmid: 17852611
references.citation: AIDS. 2005 Sep 2;19(13):1367-74
references.pmid: 16103767
references.citation: AIDS Behav. 2011 Jan;15(1):204-8
references.pmid: 19821023
references.citation: J Neurovirol. 2007 Aug;13(4):291-304
references.pmid: 17849313
references.citation: Neuropsychol Rev. 2009 Jun;19(2):169-85
references.pmid: 19424802
references.citation: Arch Clin Neuropsychol. 1993 Mar;8(2):123-35
references.pmid: 14589670
references.citation: J Neurovirol. 2007 Jun;13(3):195-202
references.pmid: 17613709
references.citation: J Int Neuropsychol Soc. 2007 Jan;13(1):1-11
references.pmid: 17166298
references.citation: J Neurovirol. 2008 Nov;14(6):536-49
references.pmid: 18991068
references.citation: Arch Gen Psychiatry. 1994 Jan;51(1):51-61
references.pmid: 8279929
references.citation: Neurosci Biobehav Rev. 2002 May;26(3):353-9
references.pmid: 12034135
references.citation: J Neurovirol. 2007;13(1):23-8
references.pmid: 17454445
references.citation: Neurology. 2008 Jul 1;71(1):50-6
references.pmid: 18591505
references.citation: Neurology. 2007 Jan 30;68(5):350-5
references.pmid: 17261681
references.citation: Neurology. 2006 Mar 28;66(6):862-6
references.pmid: 16567703
references.citation: J Acquir Immune Defic Syndr. 2007 Jun 1;45(2):174-82
references.pmid: 17356465
references.citation: Neurology. 2007 Oct 30;69(18):1789-99
references.pmid: 17914061
references.citation: J Infect Dis. 2002 May 1;185(9):1244-50
references.pmid: 12001041
references.citation: Clin Neuropsychol. 2004 May;18(2):234-48
references.pmid: 15587671
references.citation: Gerontologist. 1969 Autumn;9(3):179-86
references.pmid: 5349366
references.citation: AIDS Behav. 2004 Sep;8(3):345-55
references.pmid: 15475681
references.citation: J Clin Exp Neuropsychol. 2008 Jan;30(1):83-90
references.pmid: 17852582
references.citation: Eur J Neurol. 2000 Mar;7(2):151-8
references.pmid: 10809935
references.citation: J Affect Disord. 2006 Aug;94(1-3):269-75
references.pmid: 16764941
references.citation: AIDS Res Hum Retroviruses. 2008 Oct;24(10):1301-7
references.pmid: 18844464
references.citation: J Infect Dis. 1999 Jan;179(1):68-73
references.pmid: 9841824
references.citation: JAMA. 1994 Dec 14;272(22):1749-56
references.pmid: 7966923
references.citation: J Neurovirol. 2004 Dec;10(6):350-7
references.pmid: 15765806
references.citation: J Affect Disord. 2008 Jun;108(3):225-34
references.pmid: 18045694
references.citation: J Neurovirol. 2007;13(1):67-72
references.pmid: 17454450
references.citation: Neurology. 2006 Jul 25;67(2):311-4
references.pmid: 16864825