Characterization of HIV-Associated Neurocognitive Disorders Among Individuals Starting Antiretroviral Therapy in South Africa |
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| Authors: | John A. Joska Jennifer Westgarth-Taylor Landon Myer Jacqueline Hoare Kevin G. F. Thomas Marc Combrinck Robert H. Paul Dan J. Stein Alan J. Flisher |
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| Affiliation: | (1) Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa;(2) ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa;(3) School of Public Health and Family Medicine, Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa;(4) International Centre for AIDS Care and Treatment Programs, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA;(5) Division of Neurology, University of Cape Town, Cape Town, South Africa;(6) Department of Psychology and Behavioral Neuroscience, University of Missouri, St. Louis, MO, USA |
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| Abstract: | 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. |
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