Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region

Wright, Edwina; Brew, Bruce J.; Arayawichanont, Arkhom; Robertson, Kevin; Samintharapanya, Kanoksri; Kongsaengdao, Subsai; Lim, Megan S C; Saphonn, Vonthanak; Lal, Luxshimi; Sarim, Chel; Huffam, Sarah; Li, P; Imran, Darma; Lewis, Jennifer A.; Lun, Wenhui; Kamarulzaman, Adeeba; Tau, Goa; Ali, S T; Kishore, Kamal; Bain, Margaret P; Dwyer, Robyn; McCormack, Gavin R.; Hellard, Margaret; Cherry, Catherine L.; McArthur, Justin C.; Wesselingh, Steven Lodewyk

doi:10.1212/01.wnl.0000316390.17248.65

Cited by 79 publications

(62 citation statements)

References 27 publications

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“…Regional studies have found that as much as 40% of adults attending outpatient HIV clinics in Asia‐Pacific countries have depression 2, 3. Concomitant mental illness is associated with late antiretroviral therapy (ART) initiation and lack of timely viral suppression in people living with HIV (PLHIV) 4, 5.…”

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confidence: 99%

Barriers to mental healthcare and treatment for people living with HIV in the Asia‐Pacific

Sohn¹,

Ross²,

Wainberg

2018

J Intern AIDS Soc

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confidence: 99%

Barriers to mental healthcare and treatment for people living with HIV in the Asia‐Pacific

Sohn¹,

Ross²,

Wainberg

2018

J Intern AIDS Soc

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“…This test battery was chosen because it is sensitive to changes observed in HIV-associated neurocognitive disorders, brief, easy to administer and teach, and can be used internationally where little formal Western education exists 15 ; our tests closely resemble the battery used in a large, randomized ART HIV treatment study. 16 For all 5 tests, the raw scores of each participant were standardized to z scores by subtracting the mean test scores of matched, HIV-negative reference populations, and dividing by the reference SD.…”

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confidence: 99%

“…19 We administered the Center for Epidemiologic Studies-Depression scale (CES-D) 20 to screen for depression at baseline. The CES-D has been used in international studies in HIV-infected 15 populations. We used the recommended cutoff score of Ն16 to define depression (sensitivity 86%-100%, specificity 53%-84%).…”

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Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons

et al. 2010

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Objective: To determine factors associated with baseline neurocognitive performance in HIVinfected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Methods:Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores ϽϪ2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. Results:The 292 participants had a median CD4 cell count of 536 cells/mm 3 , 88% had an HIV viral load Յ400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was Ϫ0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. Conclusions:In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation. Neurology In advanced untreated HIV disease, HIV-associated dementia (HAD) develops in approximately 15% of patients 1 and combination antiretroviral therapy (ART) has effectively reduced the incidence of HAD.2 The Strategies for Management of Antiretroviral Therapy (SMART) study randomized participants to intermittent, CD4-guided ART or continuous ART.3 In a neurology substudy, a neurocognitive test battery was administered. We hypothesized that neurocognitive

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“…This prevalence is much higher than the average estimate (ie, 12%) of symptoms of all neurocognitive disorders in the Asia Pacific region. 53 This difference may be explained by the difference in measurement, since this study employed the IHDS, while Wright et al used a combination of several psychological test batteries. 53 However, the prevalence reported here was similar to that reported in other countries using the IHDS and the same cutoff scores for classification of those with and without probable HAD.…”

Section: Discussionmentioning

confidence: 92%

“…53 This difference may be explained by the difference in measurement, since this study employed the IHDS, while Wright et al used a combination of several psychological test batteries. 53 However, the prevalence reported here was similar to that reported in other countries using the IHDS and the same cutoff scores for classification of those with and without probable HAD. These include studies conducted in the United States (37.9%), 14 Canada (39.4%), 23 and India (35% in 2006 and 32.5% in 2014).…”

Section: Discussionmentioning

confidence: 92%

Prevalence and Correlates of Probable HIV-Associated Dementia in HIV Outpatients in Ho Chi Minh City, Vietnam

Thai

Jones

Harris

et al. 2017

J Int Assoc Provid AIDS Care

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This study identified prevalence and correlates of HIV-associated dementia (HAD) among people living with HIV (PLWHA) in Ho Chi Minh City, Vietnam. Four hundred PLWHA completed a self-report questionnaire and were interviewed by a trained researcher to assess HAD using the International HIV Dementia Scale (IHDS). Clinical information concerning HIV treatment was also extracted from medical records. The results indicate the prevalence of probable HAD based on IHDS score <10.5 was 39.8% (95% confidence interval [CI]: 35.0%-44.5%). Probable HAD was significantly higher among female, older PLWHA and among those with low education level ( primary school), moderate level of adherence to HIV medication and HIV stage 3. Those PLWHA with depressive symptoms also had higher odds of having probable HAD (odds ratio ¼ 3.23, 95% CI: 2.05-5.11). These findings underscore the importance of early HAD screening and appropriate referral for further assessment and management of PLWHA especially those with higher risk of HAD.

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Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region

Cited by 79 publications

References 27 publications

Barriers to mental healthcare and treatment for people living with HIV in the Asia‐Pacific

Barriers to mental healthcare and treatment for people living with HIV in the Asia‐Pacific

Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons

Prevalence and Correlates of Probable HIV-Associated Dementia in HIV Outpatients in Ho Chi Minh City, Vietnam

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