Elsevier

Journal of Psychiatric Research

Volume 85, February 2017, Pages 37-41
Journal of Psychiatric Research

Screening HIV-associated neurocognitive disorders (HAND) among HIV positive patients attending antiretroviral therapy in South Wollo, Ethiopia

https://doi.org/10.1016/j.jpsychires.2016.10.016Get rights and content

Abstract

Background

The vast majority of people living with HIV/AIDS reside in low and middle income countries, particularly in Sub-Saharan Africa, including Ethiopia. Despite the huge number of service users in the local area, cognitive disorder among HIV patients has not been extensively studied and there is a dearth of knowledge on the subject. The objective of this study was to assess the prevalence and associated factors of HIV-associated neurocognitive disorder among people living with HIV/AIDS in antiretroviral therapy (ART) clinics.

Methods

Institution based cross sectional study was conducted from April to May, 2015 at Dessie Referral Hospital & Kombolcha Health Center. International HIV Dementia Scale was used to screen HIV associated neurocognitive deficits. Logistic regression analysis was used to assess predictors of neurocognitive disorders.

Result

The risk of HIV associated neurocognitive disorder was 36.4%. Those who had CD4 count of 500 cells/dl or less (AOR = 2.368 (1.524, 3.680)), no formal education (AOR = 4.287 (2.619, 7.016)), poor medication adherence (AOR = 1.487 (1.010, 2.180)) and older age (AOR = 3.309 (1.259, 8.701)) were found to be significantly associated with HIV associated neurocognitive disorders.

Conclusion

The risk of HIV-associated neurocognitive disorder was found to be high among people living with HIV/AIDS. This emphasizes the need of regular cognitive screening for early identification and appropriate intervention.

Introduction

Global statistics estimated that 35 million people were living with Human Immunodeficiency Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS) in 2013, of which 24.7 million live in Sub-Sahara Africa/resource limited settings/where little HIV neurology research is conducted (Meyer, 2014).

In Ethiopia, according to 2007 single point estimate, about 1.12 million people were living with HIV in 2009, of which 336,160 were eligible for Highly Active Anti-retroviral Therapy (HAART). There were an estimated of 131,145 new infections and 44,751 AIDS related deaths (Hapco, 2010).

The human immunodeficiency virus (HIV) can cause a spectrum of neuropsychological impairment known collectively as HIV-associated neurocognitive disorder (HAND). Though the incidence of HIV-associated dementia has reduced in the HAART era; the prevalence of milder forms of HAND has increased (Cross et al., 2013a, Nabha et al., 2013, Woods et al., 2009).

HIV-associated neurocognitive disorders (HAND) is used to describe a spectrum of disorders that range from asymptomatic neurocognitive impairment to minor neurocognitive disorder to clinically severe dementia. The most severe form HIV-associated dementia also referred to as the AIDS dementia complex or HIV encephalopathy is considered an AIDS-defining illness (Fauci et al., 2015).

HAND is characterized by impaired cognitive functioning and reduced mental activity that interferes with work, domestic and social functioning. HAND and HIV/AIDS have complex and bidirectional relationship, with reported neurocognitive impairment/cognitive deficits up to 99% in symptomatic patients and 33% in non-symptomatic cases. This dramatic impact of HIV/AIDS left untreated; leading to decreased patient's quality of life, reduced ability to perform daily activities, poor medication adherence and shorter survival time (Larsson et al., 2009, Breuer et al., 2011).

A population-based longitudinal cohort study conducted to determine the risk factors of HAND among HIV-infected patients revealed that increased age, increased length of survival with diagnose of HIV-1infection, low Cluster of Differentiation (CD4) cell counts, and high viral load (>100,000copies/ml) had strong association with HAND (Mccombe et al., 2013).

There are limited studies which showed the magnitude of HIV associated neurocognitive disorders and associated factors among people living with HIV/AIDS (PLHA) in Sub-Saharan region (Nakku et al., 2013), particularly in Ethiopia. The aim of this study was to determine the magnitude and associated factors of HAND among PLHA. Hence, the findings might have importance to stakeholders and policy makers working in neuro-psychiatric areas by showing its prevalence and the factors associated with it.

Section snippets

Study settings and population

A cross sectional study was conducted at Dessie Referral Hospital (DRH) and Kombolcha Health Center (KHC) HIV care clinic. Dessie is located in South Wollo administrative zone, Amhara, National Regional state, North East Ethiopia. Dessie is the capital town of South Wollo zone, which is located 401 km Northeast of Addis Ababa (the capital city of Ethiopia). The town has an estimated population of 279,423 (2012) and has one public referral hospital, three general private hospitals, and four

Socio-demographic characteristics

Five hundred ninety three (593) people living with HIV/AIDS were involved in the study, making the response rate of 99%. The mean age of the respondents were 38.6 ± 10.6 years. Among the study participants 309 (52.1%) were females and 377 (63.6%) were married (Table 1).

HIV associated neurocognitive disorder (HAND)

Among the study participants who screened for HAND, 216 (36.4%) of them had scored 9.5 or less on IHDS. Procedural implementation of international HIV dementia scale (IHDS) was as follows: The first measurement on IHDS was timed

Discussion

In this study, the risk of HAND among people living with HIV/AIDS was 36.4% by using international HIV dementia scale (IHDS) as screening tool and IHDS performance was greatly influenced by increased age, no or low level of education, lower CD4 count and poor medication adherence.

The finding of this study was in line with the study done in Botswana (38%) (Chibanda et al., 2014), in Thailand (37.5%) (Heaps et al., 2013), and in China (37.31%) (Zhang et al., 2012) were found to have HAND. In all

Conclusion

The risk of HAND was found to be high among PLHA at Dessie Referral Hospital and Kombolcha Health Center. Increased age, no or low level of education, lower CD4 count and poor medication adherence were significantly associated with HAND. Screening of HIV associated Neurocognitive disorders for all PLHA should be done for early diagnosis and treatment in order to decrease/delay/neurocognitive dysfunctions. This finding will provide a foundation for future neurocognitive studies and clinical

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

All authors were involved in the conception, drafting and final approval of this manuscript.

Acknowledgements

This study received financial support from University of Gondar and AMSH. We would like to thank Dessie Referral Hospital and Kombolcha health Center administrative and technical staffs for their indispensible co-operations before & during data collection. We are also grateful to the study participants without whom the current study would not have been realized. Finally, we would like to thank Bahir Dar University for facility to write up in appropriate manner.

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