Screening HIV-associated neurocognitive disorders (HAND) among HIV positive patients attending antiretroviral therapy in South Wollo, Ethiopia
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.
References (21)
- et al.
HIV/AIDS and mental health research in sub-Saharan Africa: a systematic review
Afr. J. AIDS Res.
(2011) - et al.
HIV-associated neurocognitive disorders in a South Asian population:contextual application of the 2007 criteria
BMJ Open
(2012) - et al.
Mental, neurological, and substance use disorders in people living with HIV/AIDS in low-and middle-income countries
JAIDS
(2014) - et al.
HIV-associated neurocognitive disorders: antiretroviral regimen, central nervous system penetration effectiveness, and cognitive outcomes
South Afr. Med. J.
(2013) - et al.
Identifying risk factors for HIV-associated neurocognitive disorders using the international HIV dementia scale
J. Neuroimmune Pharmacol.
(2013) - et al.
A short tool to screen HIV-infected patients for mild neurocognitive disorders-a pilot study
BMC Psychol.
(2014) - et al.
Harrison's Principles of Internal Medicine
(2015) Report on progress towards implementation of the UN declaration of commitment on HIV/AIDS
AA Fed. Minist. Health
(2010)- et al.
Development of normative neuropsychological performance in Thailand for the assessment of HIV-associated neurocognitive disorders
J. Clin. Exp. Neuropsychol.
(2013) - et al.
HIV associated neurocognitive disorders (HAND) in Malawian adults and effect on adherence to combination anti-retroviral therapy
PLoS One
(2014)
Cited by (24)
HIV-1 and drug abuse comorbidity: Lessons learned from the animal models of NeuroHIV
2021, Neuroscience LettersCitation Excerpt :Despite the ability of combination antiretroviral therapy (cART) to dramatically suppress viremia, the brain continues to be a reservoir for low-level HIV-1 replication [1–6]. It has been estimated that ∼30−60% of infected individuals on the cART regimen go on to develop a varying degree of neurological dysfunction ranging from asymptomatic to mild neurocognitive impairments, collectively termed as HIV-associated neurocognitive disorders (HAND) or NeuroHIV, that significantly affects the quality of life of infected individuals [7–12]. Adding further complexity to HAND is the co-morbidity of drug abuse [13–17].
Ongoing Healthcare Disparities in neuroHIV: Addressing Gaps in the Care Continuum
2023, Current HIV/AIDS ReportsValue of Radiomic Analysis Combined With Diffusion Tensor Imaging in Early Diagnosis of HIV-Associated Neurocognitive Disorders
2023, Journal of Magnetic Resonance ImagingA Focus on Aging, HIV/AIDS, and Neurocognitive Challenges: Examining Southern Nevada HIV Sector Providers’ Awareness and Prospective Roles
2023, International Journal of Environmental Research and Public HealthNeurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies
2023, Neuropsychiatric Disease and Treatment