Association of age and time of disease with HIV-associated neurocognitive disorders: a Japanese nationwide multicenter study

Abstract

There is no detailed information on the association between age, time of disease, and HIV-associated neurocognitive disorders (HAND). In this prospective study involving 17 medical facilities across Japan, we recruited HIV-infected patients to complete a 14-test neuropsychological battery that assess eight neurocognitive domains. HAND were diagnosed by the Frascati criteria. Of 1399 recruited patients, 728 were enrolled. The prevalence of HAND was 25.3% [13.5% asymptomatic neurocognitive impairment, 10.6% mild neurocognitive disorder (MND), and 1.2% HIV-associated dementia (HAD)]. Tests that assess executive and visuospatial functions showed better diagnostic accuracy than other tests for HAND. Multivariate analysis identified age (≥ 50 years) and incomplete virological suppression as risk factors for MND and HAD and current ART as a protective factor. The prevalence of MND and HAD was low in the early stage of infection (6.3% in ≥ 2 to < 6 years), then increased in the later stage [17.3% in ≥ 11 years, p = 0.001 (vs. ≥ 2 to < 6 years)], independent of age or treatment. Older patients were more likely to show MND or HAD in the early stage of HIV infection (26.7 vs. 8.7% for < 2 years and 17.4 vs. 3.1% for ≥ 2 to < 6 years, p = 0.040 and 0.004, respectively) compared to younger ones. In conclusion, MND and HAD were more commonly found in later years since diagnosis of HIV infection and older patients are at risk of neurocognitive impairment at the early stage of HIV infection. Tests for executive and visuospatial functions seem more sensitive than other tests for diagnosing HAND.

Neurocognitive dysfunction and brain FDG-PET/CT findings in HIV-infected hemophilia patients and HIV-infected non-hemophilia patients

“…At present, neuropsychological tests standardized for sex and education level are limited in Japan; thus, advancement in the neuropsychological field is desirable. In addition, the J-HAND study demonstrated that age � 50 years and incomplete virological suppression were identified as risk factors for the symptomatic group, and current treatment with anti-HIV drugs was identified as a protective factor for neurocognitive dysfunction [8]. However, the present participants were a homogeneous population with regard to these factors.…”

“…Medical examinations were performed by a psychiatrist. In the afternoon, the same neuropsychological tests were performed in one session by the same clinical psychologist as that in the J-HAND study (8).…”

“…For control group data from HIV-infected non-hemophilia patients, the data obtained at ACC from the J-HAND study was used [8]. Three time zones (9 a.m. to 10 a.m., 10 a.m. to 11 a.m., 11 a.m. and later) were set in each of three outpatient examination rooms.…”

“…According to an investigation of HAND in Japanese HIV-infected patients, the "Epidemiological study of HIV-associated neurocognitive disorders in Japan" (the J-HAND study), the prevalence of HAND in HIV-infected patients is 25%; asymptomatic neurocognitive impairment (ANI): 13%, mild neurocognitive disorder (MND): 11%, and HIV-associated dementia (HAD): 1% [8]. According to multivariate analysis, age of � 50 years and incomplete virological suppression were identified as risk factors for the symptomatic group, and current treatment with anti-HIV drugs was identified as a protective factor.…”

Prevalence and predictors of HIV-associated Neurocognitive Disorder in Ethiopians

“…Gender, education, marital status, current CD4 count and hospital stay were included in the model based on previous studies showing them to be consistent predictors for HAND (18)(19)(20)(21)(22)(23)(24)(25). The logistic regression model was statistically signi cant, χ2(9) = 72.91.…”