The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

Wei, Jiaqi; Hou, Jun; Su, Bin; Jiang, Taiyi; Guo, Caiping; Wang, Wen; Zhang, Yang; Chang, Biru; Wu, Hao; Zhang, Tong

doi:10.3389/fneur.2020.581346

Cited by 100 publications

(93 citation statements)

References 46 publications

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“…This is consistent with Al-khindi et al (2011) and Habib et al (2013) reviews, which showed modest and substantial ART benefits in people living with HIV, respectively. However, this contrasts with recent studies that have shown no association between ART use and neurocognitive performance (Walker & Brown, 2018;Wei et al, 2020).…”

Section: Discussioncontrasting

confidence: 83%

“…The global prevalence of HIV-associated neurocognitive impairment in the antiretroviral era is estimated at 43-45% (Wang et al, 2020;Wei et al, 2020). Varying prevalence rates have been reported in studies conducted in low-and middleincome countries in the range of 12-74% (Michael et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…While the debate on prevalence estimates of HAND based on the Frascati criteria lingers, it is reassuring that most cases of HIV-associated neurocognitive impairment are asymptomatic (Gisslen et al, 2011;Nightingale et al, 2020). However, there are reports that income group of a country is associated with HIV-associated neurocognitive impairment (Robertson et al, 2011;Wei et al, 2020), especially as low-and middle-income countries grapple with poverty, political instability, gender-based violence, malnutrition, and poorly developed health and education infrastructure (Shao & Williamson, 2012). In addition to these socioeconomic factors, the clinical context of the HIV epidemic within lowand middle-income countries has further contributed to the high burden of HIV-associated neurocognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment programs managed by national government institutions, donors, and non-governmental organizations drive the choice of regimens that are more convenient, affordable, and safe (World Health Organization, 2016). However, these regimens have varied pretreatment drug resistance, drug-drug interactions, side effects, central penetrating effectiveness (CPE), and neurotoxicity that impact neuropsychological performance (Cysique et al, 2011;Ndashimye & Arts, 2019;Wei et al, 2020). Before the migration toward a first-line Dolutegravir-based ART regimen in low-and middle-income countries, Efavirenz was the preferred non-nucleoside reverse transcriptase backbone (NNRTI) (Bednasz et al, 2019;World Health Organization, 2016.…”

Section: Introductionmentioning

confidence: 99%

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A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

et al. 2021

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HIV-associated neurocognitive impairment remains a challenge even in the era of antiretroviral therapy (ART). Over 90% of people living with HIV are in low-and middle-income countries. Hence, it is not surprising that such countries bear a considerable burden of comorbidities like HIV-associated neurocognitive impairment despite an overall increase in life expectancy. The literature suggests differences in patient characteristics, clinical profile, prevalent HIV subtypes, treatment choices, pharmacogenetics, and socioeconomic factors between low-and middle-income countries compared with highincome countries. Therefore, we aimed to evaluate the effect of ART on neurocognitive outcomes in low-and middle-income countries. A comprehensive search of five databases (PubMed, CINAHL, CENTRAL, PsychInfo, Google scholar) for studies published between 1996 to 2020 was performed to identify studies that reported neurocognitive outcomes in ART-treated and ART naïve HIV positive individuals. Two independent reviewers conducted study screening, data extraction, and evaluation of the risk of bias. Pooled effect size estimates (Hedges' g) and 95% CI were computed using random-effects models. Sensitivity analysis, subgroup analysis, meta-regression, and evaluation of publication bias were also conducted. Forty studies (24 cross-sectional, 13 longitudinal studies, and two randomized controlled trials) contributed to a series of meta-analyses. We found significant small to moderate effects of antiretroviral therapy for global cognition (Hedges' g observed = 0.30; 95% CI: 0.15, 0.44; k = 25; p = 0.0003; I 2 = 92.1%; tau = 0.32; Q = 305.1), executive function (Hedges' g = 0.24, 95%CI: 0.02,0.46; p-0.04; k = 8; I 2 = 37.5%; tau = 0.23; Q = 11.2), and speed of information processing (Hedges' g = 0.25, 95% CI: 0.05, 0.45; k = 9; p = 0.02; I 2 = 86.4%; tau = 0.21; Q = 58.9). We found no significant ART effect on attention-working memory, learning and memory, motor function, and verbal fluency. No significant effect was seen with the duration of therapy, efavirenz use, and Central Penetrating Effectiveness (CPE) of antiretroviral therapy. Subgroup analyses identified study design (betweengroup and within-group; cross-sectional and longitudinal) and normative scores as significant sources of heterogeneity. Metaregression analysis indicated that nadir CD4 modified the magnitude of ART's effect on cognitive outcomes. Age, gender, and country income-group were not significant moderators. Our findings provide systematic evidence that antiretroviral therapy improves neurocognitive outcomes in the domains of global cognition, executive function and speed of information processing, of people living with HIV in low-and middle-income countries, especially those with advanced immunosuppression. However, these findings are not definitive as they are limited by the probability of publication bias, high heterogeneity, and exclusion of significant confounders. Prospero registration number: CRD42020203791.

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Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

et al. 2021

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“…Moreover, examples such as HIV-associated neurocognitive dysfunction, which afflicts over 40% of people with chronic HIV infection [65], impairing learning, memory, attention, and executive function, suggests possible overlap across multiple chronic viral infections. A recent study in Nature illustrates how such higher order disruptions may be mediated on a molecular level through viral-associated perturbations in general cellular functions such as cortical excitatory synaptic signalling, choroid plexus disruption enabling peripheral T cell infiltration, and promotion of pathological microglial and astrocyte subpopulations [66].…”

Section: Comparison With Previous Empirical Studiesmentioning

confidence: 99%

“I can’t cope with multiple inputs”: Qualitative study of the lived experience of ‘brain fog’ after Covid-19

Callan

Ladds

Hussain

et al. 2021

Preprint

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Objective To explore the lived experience of brain fog i.e the wide variety of neurocognitive symptoms that can follow Covid-19. Design and setting UK wide longitudinal qualitative study comprising online interviews and focus groups with email follow-up. Method 50 participants were recruited from a previous qualitative study of the lived experience of long Covid (n = 23) and online support groups for people with persistent neurological problems following Covid-19 (n = 27). In remotely held focus groups, participants were invited to describe their cognitive symptoms and comment on others accounts. Individuals were followed up by email 4-6 months later. Data were audiotaped, transcribed, anonymised and coded in NVIVO. They were analysed by an interdisciplinary team with expertise in general practice, clinical neuroscience, the sociology of chronic illness and service delivery, and checked by three people with lived experience of brain fog. Results 84% of participants were female and 60% were White British ethnicity. Most had never been hospitalised for Covid-19. Qualitative analysis revealed the following themes: mixed views on the appropriateness of the term brain fog; rich descriptions of the experience of neurocognitive impairments (especially executive function, attention, memory and language), accounts of how the illness fluctuated, and in some but not all cases, resolved, over time; the profound psychosocial impact of the condition on relationships, personal and professional identity; self-perceptions of guilt, shame and stigma; strategies used for self-management; challenges accessing and navigating the healthcare system; and participants search for physical mechanisms to explain their symptoms. Conclusion These qualitative findings complement research into the epidemiology and underlying pathophysiological mechanisms for neurological symptoms after Covid-19. Services for such patients should include: an ongoing therapeutic relationship with a clinician who engages with the illness in its personal, social and occupational context as well as specialist services that are accessible, easily navigable, comprehensive, and interdisciplinary.

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Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIV

Wei

Hou

et al. 2022

JAMA Netw Open

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IMPORTANCEIn the era of antiretroviral therapy (ART), the incidence of HIV-associated neurocognitive disorder (HAND) has not yet been controlled. With the exception of ART, there is no beneficial pharmacologic treatment. However, some studies have reported that computerized cognitive training (CCT) programs may improve cognitive function among people living with HIV. OBJECTIVE To examine the association between CCT programs and 8 domains measuring cognitive function (7 domains) and daily function (1 domain) among people living with HIV.

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The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis

Cited by 100 publications

References 46 publications

A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

“I can’t cope with multiple inputs”: Qualitative study of the lived experience of ‘brain fog’ after Covid-19

Evaluation of Computerized Cognitive Training and Cognitive and Daily Function in Patients Living With HIV

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