title: A multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings.
abstract: Little is known about how the prevalence and incidence of neurological disease in HIV-infected patients in resource-limited settings. We present an analysis of neurological and neurocognitive function in antiretroviral naïve individuals in multinational resource-limited settings. This prospective multinational cohort study, a substudy of a large international randomized antiretroviral treatment trial, was conducted in seven low- and middle-income countries in sub-Saharan Africa, South America, and Asia. Subjects were HIV-infected and met regional criteria to initiate antiretroviral therapy. Standardized neurological examination and a brief motor-based neuropsychological examination were administered. A total of 860 subjects were studied. Overall 249 (29%) had one or more abnormalities on neurological examinations, but there was a low prevalence of HIV-associated dementia (HAD) and minor neurocognitive disorder (MND). Twenty percent of subjects had evidence of peripheral neuropathy. There were significant differences across countries (p < 0.001) in neuropsychological test performance. In this first multinational study of neurological function in antiretroviral naïve individuals in resource-limited settings, there was a substantial prevalence of peripheral neuropathy and low prevalence of dementia and other CNS diseases. There was significant variation in neurocognitive test performance and neurological examination findings across countries. These may reflect cultural differences, differences in HIV-related and unrelated diseases, and variations in test administration across sites. Longitudinal follow-up after antiretroviral treatment initiation may help to define more broadly the role of HIV in these differences as well as the impact of treatment on performance.
authors.affiliation: University of North Carolina, Chapel Hill, NC 27599-7025, USA. kevinr@neurology.unc.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Robertson
authors.forename: Johnstone
authors.initials: J
authors.lastname: Kumwenda
authors.forename: Khuanchai
authors.initials: K
authors.lastname: Supparatpinyo
authors.forename: Jeanne H
authors.initials: JH
authors.lastname: Jiang
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Robert
authors.initials: R
authors.lastname: Murphy
authors.forename: Colin
authors.initials: C
authors.lastname: Hall
authors.forename: Christina M
authors.initials: CM
authors.lastname: Marra
authors.forename: Cheryl
authors.initials: C
authors.lastname: Marcus
authors.forename: Baiba
authors.initials: B
authors.lastname: Berzins
authors.forename: Reena
authors.initials: R
authors.lastname: Masih
authors.forename: Breno
authors.initials: B
authors.lastname: Santos
authors.forename: Marcus T
authors.initials: MT
authors.lastname: Silva
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Ann
authors.initials: A
authors.lastname: Walawander
authors.forename: Apsara
authors.initials: A
authors.lastname: Nair
authors.forename: Srikanth
authors.initials: S
authors.lastname: Tripathy
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kanyama
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Silvia
authors.initials: S
authors.lastname: Montano
authors.forename: Alberto
authors.initials: A
authors.lastname: La Rosa
authors.forename: Farida
authors.initials: F
authors.lastname: Amod
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Cindy
authors.initials: C
authors.lastname: Firnhaber
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Pim
authors.initials: P
authors.lastname: Brouwers
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001208:Asia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011115:Polyneuropathies / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013020:South America / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents