Characterization of HIV-Associated Neurocognitive Disorders among individuals starting antiretroviral therapy in South Africa.
HIV-Associated Neurocognitive Disorders (HAND) exert an impact on everyday functions, including adherence. The prevalence of and risk factors for HAND in patients commencing anti-retroviral therapy in Southern Africa are unknown. Participants from primary care clinics in Cape Town, South Africa underwent detailed neuropsychological, neuropsychiatric, and neuromedical evaluation. Using the updated American Academy of Neurology (AAN) criteria, participants were classified into categories of HAND, and demographic and clinical risk factors for HIV-dementia (HIV-D) were assessed. The prevalence of mild neurocognitive disorder (MND) and HIV-D were 42.4 and 25.4%, respectively. There were significant associations between lower levels of education and older age with HIV-D, and a trend to association with HIV-D and lower CD4 count. In a regression model, a lower level of education and male gender were predictive of HIV-D. These findings suggest that HAND are highly prevalent in primary care settings in South Africa where clade C HIV is predominant.
Joska
John A
JA
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. John.Joska@uct.ac.za
Westgarth-Taylor
Jennifer
J
Myer
Landon
L
Hoare
Jacqueline
J
Thomas
Kevin G F
KG
Combrinck
Marc
M
Paul
Robert H
RH
Stein
Dan J
DJ
Flisher
Alan J
AJ
D015526:AIDS Dementia Complex / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult