Effects of HIV infection, antiretroviral therapy, and immune status on the speed of information processing and complex motor functions in adult Cameroonians

Abstract

HIV-associated neurocognitive deficits include impaired speed-of-information processing (SIP) and motor functions. There is lack of Cameroonian adult norms for assessing SIP or motor functions. This study of 683 Cameroonians (320 HIV+, 363 HIV−) establishes demographically-adjusted norms for six SIP [Wechsler-Adult-Intelligence-Scale (WAIS)-III Digit Symbol (WAIS-IIIDS) and Symbol Search (WAIS-IIISS), Stroop Color-Naming, Stroop Word-Reading, Trail-Making Test-A (TMT-A), Color Trails-1 (CTT1)], and two motor function [Grooved Pegboard-dominant (GP-DH) and non-dominant (GP-NDH) hands] tests. We assessed viral effects on SIP and motor functions. HIV-infected persons had significantly lower (worse) T scores on GP-DH, WAIS-IIIDS, Stroop Word-Reading, TMT-A; lower motor and SIP summary T scores. Significantly higher proportion of cases (20.7%) than controls (10.3%) had impaired SIP. Male cases had better T scores than female cases on GP-NDH, WAIS-IIIDS, WAIS-IIISS, TMT-A, CTT1; better SIP summary T scores. Antiretroviral therapy (ART) was associated with significantly better T scores on GP-NDH, WAIS-IIIDS, Stroop Color-Naming; better motor and SIP summary T scores. Cases with higher CD4 had better T scores on WAIS-IIIDS, TMT-A, CTT1; better SIP summary T scores. Overall, we demonstrate that HIV infection in Cameroon is associated with deficits in SIP and motor functions; ART and higher CD4 are associated with better cognitive performance. We provide SIP and psychomotor functions normative standards, which will be useful for neurobehavioral studies in Cameroon of diseases affecting the brain. Diseases that affect the central nervous system (CNS) often result in impaired cognition. This is the case for HIV/AIDS, where in the early stages of infection, the virus induces blood-brain barrier injury, enters the CNS, and productively infects resident macrophages and glial cells 1,2. This infection of CNS cells, production and release of HIV virions and viral proteins into the brain, as well as subsequent increased inflammation and oxidative stress, can cause neuronal injury and death, and result in behavioral, motor and cognitive abnormalities termed HIV-associated neurocognitive disorders (HAND) 2-4. Antiretroviral therapy (ART) is associated with improved cognition 5-8 and ART failure correlates with poor performance on tests of neurocognitive function 9. Cross-sectional and longitudinal studies have shown that the odds of neurocognitive impairment increased in

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Dementia in Africa: Current evidence, knowledge gaps, and future directions

“…95 Substantial evidence abounds demonstrating HIV as a cause of neurocognitive disorders with about two-thirds of people living with HIV diagnosed with probable HIV-associated neurocognitive disorder (HAND). [96][97][98][99][100][101][102] With more than 11.3 million human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients affected by HAND, 98 it has been suggested that the burden of HAND in Africa is likely to rank among the highest of any region in the world. There are several reasons for the high burden of HAND on the continent.…”

“…Examples of normative data have been reported from Cameroon in the pediatric and adult populations. 99,153 For functional assessment, the Clinician Home-based Interview to assess Function (CHIF) was developed and validated by the Indianapolis-Ibadan dementia research group. 154 The IDEA study Instrumental Activities of Daily Living (IDEA-IADL) was also recently developed and validated among rural-dwelling Tanzanians.…”

“…The next important step for promoting reliable cognitive evaluation in Africa is the development of normative data across the lifespan, based on the validated culturally sensitive neuropsychological test batteries and screening instruments. Examples of normative data have been reported from Cameroon in the pediatric and adult populations 99,153 …”