Neurobehavioral Effects in HIV-Positive Individuals Receiving Highly Active Antiretroviral Therapy (HAART) in Gaborone, Botswana

Abstract

ObjectiveTo explore the prevalence and features of HIV-associated neurocognitive disorders (HANDS) in Botswana, a sub-Saharan country at the center of the HIV epidemic.Design and MethodsA cross sectional study of 60 HIV-positive individuals, all receiving highly active antiretroviral therapy (HAART), and 80 demographically matched HIV-seronegative control subjects. We administered a comprehensive neuropsychological test battery and structured psychiatric interview. The lowest 10th percentile of results achieved by control subjects was used to define the lower limit of normal performance on cognitive measures. Subjects who scored abnormal on three or more measures were classified as cognitively impaired. To determine the clinical significance of any cognitive impairment, we assessed medication adherence, employment, and independence in activities of daily living (ADL).ResultsHIV+ subjects were impaired for all cognitive-motor ability areas compared with matched, uninfected control subjects. Thirty seven percent of HIV+ patients met criteria for cognitive impairment.ConclusionThese findings indicate that neurocognitive impairment is likely to be an important feature of HIV infection in resource-limited countries; underscoring the need to develop effective treatments for subjects with, or at risk of developing, cognitive impairment.

Use of Western Neuropsychological Test Battery in Detecting HIV-Associated Neurocognitive Disorders (HAND) in Zambia

“…Furthermore, the AIDS group performed worse than the HIV+ without AIDS group on the Recall Mean T score results. Similar to Vance et al, [37] and Lawler et al, [46], nadir and current CD4 count, BMI and initial and current WHO stages were not related to NP performance, possibly because our HIV+ sample all had similarly low nadir CD4, and were on CART with improved CD4 counts and WHO staging; additionally, their BMI levels were not categorically low.The fact that almost everyone in our sample had a similar low nadir CD4 of <200 cells/ml is because, until recently, CART in Zambia was typically initiated for patients who had a CD4 of <200 cells/ml in WHO stage three or four [52, 53]. Consequently, our sample was comprised of individuals with lower nadir CD4 than is reported in other studies, especially those in the West where nadir CD4 has been found to be a consistent predictor of NP functioning.…”

“…These findings are consistent with that of Gupta et al [44] in India who reported that in a clade C HIV+ sample, NP domains of Fluency, Learning, Working Memory and Episodic Memory were impaired compared to the HIV− controls. Lawler [46] also reported NP impairments for a clade C HIV+ sample in Botswana in the areas of verbal learning and delayed free recall. Uganda, which has HIV clades A and D, similarly yielded findings that the HIV+ were impaired in Learning, Memory, Speed of Information Processing, Attention and Executive Functioning compared to the HIV− group [14].…”

Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal, South Africa

“…Alternatively, this memory loss may indicate possible HIV-related cognitive deficit. Research conducted in a southern African context [35][36][37] has outlined the neurocognitive deficits related to HIV, which include problems with memory. Whatever the explanation for this apparent anomaly, the onus rests on physiotherapists to continually educate patients with regard to both a wider explanation of the profession itself as well as the specific goals of each individual rehabilitation programme.…”

HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

“…Joska et al reported that 23.5% of their 536 participants in urban South Africa were diagnosed with HIV-associated neurocognitive disorder (HAND). Lawler et al (2011) reported that 37% of people living with HIV were described as cognitively impaired [35][36][37] and Bhat et al identified significant loss of memory in 17.9% of their sample of 168 patients at a rural health centre in South Africa [38]. The study by Lawler et al which used a control group, reported that HIV-positive participants were more impaired on neuropsychological measures when compared to demographically-matched controls for all cognitive-motor ability areas, which included processing speed, verbal learning/memory, language, psychomotor speed, executive function, and fine motor speed [37].…”