title: Neurobehavioral effects in HIV-positive individuals receiving highly active antiretroviral therapy (HAART) in Gaborone, Botswana.
abstract: OBJECTIVE
  To explore the prevalence and features of HIV-associated neurocognitive disorders (HANDS) in Botswana, a sub-Saharan country at the center of the HIV epidemic.
  
  
  METHODS
  A cross sectional study of 60 HIV-positive individuals, all receiving highly active antiretroviral therapy (HAART), and 80 demographically matched HIV-seronegative control subjects. We administered a comprehensive neuropsychological test battery and structured psychiatric interview. The lowest 10(th) percentile of results achieved by control subjects was used to define the lower limit of normal performance on cognitive measures. Subjects who scored abnormal on three or more measures were classified as cognitively impaired. To determine the clinical significance of any cognitive impairment, we assessed medication adherence, employment, and independence in activities of daily living (ADL).
  
  
  RESULTS
  HIV+ subjects were impaired for all cognitive-motor ability areas compared with matched, uninfected control subjects. Thirty seven percent of HIV+ patients met criteria for cognitive impairment.
  
  
  CONCLUSIONS
  These findings indicate that neurocognitive impairment is likely to be an important feature of HIV infection in resource-limited countries; underscoring the need to develop effective treatments for subjects with, or at risk of developing, cognitive impairment.
authors.affiliation: Center for AIDS Research and Botswana-UPenn Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America. kathy.lawler@uphs.upenn.edu
authors.forename: Kathy
authors.initials: K
authors.lastname: Lawler
authors.forename: Kealeboga
authors.initials: K
authors.lastname: Jeremiah
authors.forename: Mosepele
authors.initials: M
authors.lastname: Mosepele
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Catherine
authors.initials: C
authors.lastname: Cherry
authors.forename: Esther
authors.initials: E
authors.lastname: Seloilwe
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001519:Behavior / Q000187:drug effects / Q000502:physiology; D001902:Botswana / Q000453:epidemiology; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D013647:Task Performance and Analysis; D055815:Young Adult