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Original Research
HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study
Submitted: 27 January 2017 | Published: 26 September 2017
About the author(s)
Jade C. Mogambery, Department of Internal Medicine, Ngwelezana Hospital, University of KwaZulu-Natal, South AfricaHalima Dawood, Department of Internal Medicine, Infectious Diseases Unit, Grey’s Hospital, University of KwaZulu-Natal, South Africa
Douglas Wilson, Department of Internal Medicine, Edendale Hospital, University of KwaZulu-Natal, South Africa
Anand Moodley, Department of Neurology, Grey’s Hospital, University of KwaZulu-Natal, South Africa
Abstract
Objectives: This prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal. Factors associated with HAND were examined, alternate neurocognitive tools were tested against the international HIV dementia scale (IHDS) score and an association between HAND and non-adherence to antiretroviral therapy (ART) was explored.
Methods: Between May 2014 and May 2015, 146 ART-naïve outpatients were assessed for HAND. IHDS score ≤ 10 established a diagnosis of HAND. Functional capacity was assessed using Eastern Cooperative Oncology Group (ECOG) score. Chi-squared test was used to identify risk factors for HAND. The get-up-and-go test (GUGT) and Center for Epidemiological Studies Depression scale – revised (CESD-r) were tested against the IHDS. HIV viral load done six months after initiating ART was used as a surrogate marker for adherence to ART.
Results: The prevalence of HAND was 53%. In total, 99.9% of patients with HAND had no functional impairment. Age > 50 years old was associated with HAND (p = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence (p = 0.06).
Conclusions: While the prevalence of HAND is high, it is not associated with functional impairment which suggests that asymptomatic neurocognitive impairment is prevalent. Age > 50 years old is a risk factor for HAND. The GUGT and CESD-r are not useful diagnostic tools for HAND. The relationship between HAND and non-adherence should be further explored.
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