title: Neurocognitive impairment in HIV-1-infected adults in Sub-Saharan Africa: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate the burden of HIV neurocognitive impairment (NCI) among adult patients on and off antiretroviral therapy (ART) in Sub-Saharan Africa.
  
  
  METHODS
  Estimates were derived from a random effects meta-analysis of prospective studies reporting HIV status, utilization of ART, and the presence of NCI determined using the International HIV Dementia Scale.
  
  
  RESULTS
  Sixteen studies with quality data from seven countries in Sub-Saharan Africa up to June 2012 were included. Among HIV patients, the frequency of NCI pre-ART was 42.37% (95% confidence interval (CI) 32.18-52.56%), and among those on ART for ≥6 months was 30.39% (95% CI 13.17-47.61%). Respective NCI estimates in studies from Uganda were 46.49% (95% CI 30.62-62.37%) and 28.50% (95% CI -1.31-58.30%). NCI was more common among patients with a concomitant psychiatric ailment. HIV-positive patients compared to HIV-negative controls were predisposed to NCI (odds ratio (OR) 6.49, 95% CI 1.68-25.08); the estimated unadjusted attributable risk of HIV infection leading to NCI was 85%. Meta-regression showed no associations between age, gender, CD4 cell counts, or years of education with NCI. Patients on ART were less likely to have NCI compared to HIV-infected pre-ART patients, with OR 0.36 (95% CI 0.19-0.69). In longitudinal studies with the same patients followed before and at ≥6 months after ART, the OR of NCI after ART compared to pre-ART was 0.23 (95% CI 0.14-0.37). The combined burden of NCI among pre-ART and on-ART patients in Sub-Saharan Africa was estimated at 8,121,910 (95% CI 5,772,140-10,471,680). No publication bias was observed, although residual confounding from differing environmental factors, stages of HIV infection, and viral clades might be a limitation.
  
  
  CONCLUSIONS
  HIV strongly predisposes to NCI leading to a huge burden in Sub-Saharan Africa, and scale-up of ART can substantially reduce it.
authors: Infectious and Tropical Diseases Unit, Department of Medicine, Bayero University Kano, PMB 3011, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria. Electronic address: abdulrazaq_habib@yahoo.co.uk.
authors: Abdulrazaq G
authors: AG
authors: Habib
authors: Ahmad M
authors: AM
authors: Yakasai
authors: Lukman F
authors: LF
authors: Owolabi
authors: Aliyu
authors: A
authors: Ibrahim
authors: Zaharaddeen G
authors: ZG
authors: Habib
authors: Mustafa
authors: M
authors: Gudaji
authors: Kamilu M
authors: KM
authors: Karaye
authors: Daiyabu A
authors: DA
authors: Ibrahim
authors: Ibrahim
authors: I
authors: Nashabaru
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D064887:Observational Studies as Topic; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; Antiretroviral therapy; Dementia; Human immunodeficiency virus; Neurocognitive impairment