Development of normative neuropsychological performance in Thailand for the assessment of HIV-associated neurocognitive disorders

Abstract

International studies of HIV-associated neurocognitive disorder (HAND) are needed to determine the viral and host factors associated with cognitive impairment particularly as more than 80% of HIV+ subjects reside in resource-limited settings. Recent diagnostic nomenclature of HAND requires comparison of cognitive performance specifically to local normative data. To evaluate this need for local norms, we compared normative data obtained locally in Thailand to Western norms. The current study examined cognitive performance in 477 seronegative Thai participants (male=211, female=266) who completed a battery of tests sensitive to cognitive changes in HIV. The cohort was divided into three age brackets (20–34; 35–49; 50–65) and four educational levels (no education or primary education, less than secondary certificate, high school/associates degree, Bachelor’s degree or greater). The Thai cohort was compared (using ANCOVA) on a number of measures to a seronegative US cohort (n=236; male=198 female=38) to examine cultural differences in performance. Normative data are provided with age and education stratification. The Thai and US groups performed significantly differently on all neuropsychological measures with the exception of verbal fluency. The Thai group performed better on measures of verbal learning (p<0.001) and memory (p<0.001), and measures of psychomotor speed (p<0.001). Education was a more powerful predictor of performance in the Thai cohort compared to the US group. These results highlight the continued need for the development of normative data within local populations. The use of Western norms as a comparison group could lead to inaccurate identification of HAND in culturally distinct groups.

Monocyte Infection Dynamics Shape HIV-1 Phyloanatomy in the Peripheral Blood

“…The low frequency (<1%) of HIV-infected monocytes in the peripheral 19 blood and the difficulty of obtaining tissue samples present major barriers 20 to elucidating the dynamics of HIV infection in human monocytes. [10] 21 Earlier studies focusing on circulating monocytes revealed genetic patterns 22 distinct from that of T cells, [11][12][13] consistent with the hypothesis of 23 differing viral population dynamics. However, investigation of the role(s) of 24 monocytes in the evolution and spread of HIV-1 has been largely limited to 25 the differentiated macrophage phenotype.…”

Neuronal-Glia Markers by Magnetic Resonance Spectroscopy in HIV Before and After Combination Antiretroviral Therapy

“…14 We conducted consensus conferences with two of the authors (VV, RP) and a US neurologist to assign HAND diagnoses using 2007 Frascati criteria. 15 We calculated a composite neuropsychological testing score (NPZ- global) as the arithmetic mean of age- and education-adjusted z-scores for performance on individual tests using normative data from over 500 Thai controls 16 .…”

Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy

“…We utilized an existing normative NP testing database of HIV-uninfected Thai control participants (n= 449) [19]. For the purpose of this study, we utilized only the 251 HIV-uninfected controls in the similar age range as our AHI participants.…”