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HIV associated neurocognitive disorder in a peri-urban HIV
clinic in KwaZulu-Natal, South Africa
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Reported by Jules Levin
Durban 2016 July 18-22
JC Mogambery1, H Dawood2, D Wilson3, A Moodley4
1 Grey's Hospital, Infectious Disease Unit, UKZN
2 Grey's Hospital, Infectious Disease Unit, UKZN, CAPRISA
3 Edendale Hospital, Department of Internal Medicine, UKZN
4 Grey's Hospital, Department of Neurology, UKZN
Abstract
Background: The prevalence of HIV associated neurocognitive disorder (HAND) in KwaZulu-Natal has not been established. This prospective, cross-sectional study determined the prevalence of HAND in ART naïve patients attending a peri-urban HIV clinic. The impact of HAND on functional capacity and factors associated with HAND were examined. Alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score. An association between HAND and non-adherence to ART was explored.
Methods: Between May 2014 and May 2015, 146 ART naïve outpatients were assessed prior to commencing ART electively. HAND was diagnosed using an IHDS score ≤ 10. Functional capacity was assessed using the eastern cooperative oncology group (ECOG) score. The get-up-and-go test and center for epidemiological studies depression scale - revised (CESD-R) were performed at the same consultation and correlation between these two tests and IHDS was determined. A HIV viral load done 6 months after initiating ART was used as a surrogate marker for adherence to ART.
Results: The prevalence of HAND determined by the IHDS was 78/146 (53%). ECOG score was 0 in 99.9% of patients with HAND. CD4 count ≤ 200 cells/mm³ (p=0.17) and alcohol consumption (p=0.17) were not associated with HAND. There was no correlation between the get-up-and-go test, CESD-R and the IHDS score. Of the 129/146 patients with 6 month viral loads assays a detectable viral load was found in 24/69(35%) with HAND and 12/60(20%) without HAND. There was no significant association between HAND and a detectable viral load after 6 months of ART use (p=0.06).
Conclusions: Whilst the prevalence of HAND was high, it was not associated with impaired functional capacity. This finding suggests that early asymptomatic disease was prevalent in this population. A low CD4 count was not associated with HAND. The get-up-and-go-test and CESD-R were not useful in the diagnosis of HAND. A further study is needed to determine whether a relationship between HAND and non-adherence to ART exists.
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