Assessment of neurocognitive disorders in HIV infected patients receiving combination of anti-retroviral therapy at a tertiary care hospital - An observational study
DOI:
https://doi.org/10.56511/JIPBS.2023.10201Abstract
cART Therapy (combination antiretroviral therapy) has improved the live expectancy of people living with HIV (PLHIV). But HIV associated neurocognitive disorders (HAND) are still prevalent. One of the factors associated could be the cART therapy itself. The study aims to calculate the prevalence of HAND and associated risk factors in PLHIV who are on Cart therapy and to compare the efficiency of MMSE and IHDS scales in the assessment of HAND. A case-control study involving 54 PLHIV on cART therapy and 27 HIV negative controls were screened for their neurocognition by two neuropsychological tests such as MMSE and IHDS, followed by staging into Asymptomatic Neurological Impairment (ANI), Mild Neurocognitive Impairment (MND), HIV Associated Dementia (HAD) in PLHIV. Statistical analysis was done using suitable software. The overall prevalence of HAND in our study was found to be 70.37%. Prevalence estimates for specific HAND diagnoses were 57.89% ANI, 28.9% MND, and 13.1 % HAD. IHDS demonstrated good screening ability for HAND with an optimal cut-off score of 10, high sensitivity of 70% and minimal specificity. Age, male gender, low literacy, presence of comorbidities, severity of the disease, cART regimen with low CPE (CNS penetration effectiveness) score were strongly correlated. Study findings suggest that IHDS serves as a better screening tool for HAND with greater sensitivity and can facilitate further cognitive evaluation. The overall prevalence was found to be equivalent to that of the recently reported studies.
Keywords:
HIV associated neurocognitive disorders, combination antiretroviral therapy, neuropsychological tests, ; Mini-Mental State Examination, International HIV Dementia ScaleDownloads
References
Ene L, Duiculescu D, Ruta SM. How much do antiretroviral drugs penetrate into the central nervous system? Journal of medicine and life. 2011; 4(4):432.
Gisslen M, Hagberg L. Antiretroviral treatment of central nervous system HIV ‐ 1 infection: a review. HIV medicine. 2001; 2(2):97 - 104.
Kami - Onaga K, Tateyama M, Kinjo T, Parrott G, Tominaga D, Takahashi - Nakazato A, Nakamura H, Tasato D, Miyagi K, Maeda S, Arae H. Comparison of two screening tests for HIV - Associated Neurocognitive Disorder suspected Japanese patients with respect to cART usage. 2018; 13(6):e0199106.
Valcour V, Paul R, Chiao S, Wendelken LA, Miller B. Screening for cognitive impairment in human immunodeficiency virus. Clinical Infectious Diseases. 2011; 53(8):836 - 42.
Wagner GA, Chaillon A, Siqi LI, Franklin Jr DR, Caballero G, Pond SL, Vaida F, Heaton RK, Letendre SL, Grant I, Richman DD. HIV - associated neurocognitive disorder is associated with HIV - 1 dual infection. AIDS (London, England). 2016; 30(17):2591.
Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera - Mindt M. HIV - associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology. 2010; 75(23):2087 - 96.
McRae M. HIV and viral protein effects on the blood brain barrier. Tissue barriers. 2016; 4(1):e1143543.
Nyundo AA, Ndetei DM, Othieno CJ, Mathai AM. The performance of International HIV dementia Scale (IHDS) versus Mini Mental Status Examition Scale (MMSE) in assessment of HIV - associated Neurocognitive Disorders (HAND) among HIV - Infected Tanzanian adults: a Case - Control Study.
Gandhi NS, Moxley RT, Creighton J, Roosa HV, Skolasky RL, Selnes OA, McArthur J, Sacktor N. Comparison of scales to evaluate the progression of HIV - associated neurocognitive disorder. HIV therapy. 2010; 4(3):371 - 9.
Baker LM, Paul RH, Heaps - Woodruff JM, Chang JY, Ortega M, Margolin Z et al. The effect of central nervous system penetration effectiveness of highly active antiretroviral therapy on neuropsychological performance and neuroimaging in HIV infected individuals. Journal of Neuroimmune Pharmacology. 2015; 10(3):487 - 92.
Robertson KR, Smurzynski M, Parsons TD, Wu K, Bosch RJ, Wu J, McArthur JC, Collier AC, Evans SR, Ellis RJ. The prevalence and incidence of neurocognitive impairment in the HAART era. Aids. 2007; 21(14):1915 - 21.
Kranick SM, Nath A. Neurologic complications of HIV - 1 infection and its treatment in the era of antiretroviral therapy. CONTINUUM: Lifelong Learning in Neurology. 2012; 18(6 Infectious Disease):1319.
Comparison of the Minimental State Examination Scale and the International HIV Dementia Scale in Assessing Cognitive Function in Nigerian HIV Patients on Antiretroviral Therapy. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463159/
Hu X, Zhou Y, Long J, Feng Q, Wang R, Su L, et al. Diagnostic accuracy of the International HIV Dementia Scale and HIV Dementia Scale: A meta - analysis. Exp Ther Med. 2012; 4(4):665 – 8.
Nyundo AA, Ndetei DM, Othieno CJ, Mathai AM. Neurocognitive correlates of the use of combined Antiretroviral Therapy among HIV - infected adults attending care and treatment center at Muhimbili National Hospital, Dar es Salaam, Tanzania: An analytical cross - sectional study. Tanzania Med J. 2016; 27(1):114 – 32. Available from: http://tmj.or.tz/index.php/tmj/article/view/201
Liner KJ, Ro MJ, Robertson KR. HIV, antiretroviral therapies, and the brain. Vol. 7, Current HIV/AIDS Reports. Curr HIV/AIDS Rep; 2010 ; 85 – 91.
Garvey L, Winston A, Walsh J, Post F, Porter K, Gazzard B, et al . Antiretroviral therapy CNS penetration and HIV - 1 - associated CNS disease. Neurology. 2011; 76(8):693 – 700.
Mupawose A. The effects of highly active antiretroviral therapy on the cognitive - linguistic abilities of adults living with HIV and AIDS in south africa a thesis submitted in fulfilment of the requirements for the degree of doctor of philosophy, in the faculty of humanities, university of the witwatersrand. 2012.
Valcour VG. Evaluating cognitive impairment in the clinical setting: Practical screening and Assessment tools. Top Antivir Med. 2011;19(5):175 – 80.
Pereda M, Ayuso - Mateos JL, Gómez Del Barrio A, Echevarria S, Farinas MC, García Palomo D, et al . Factors associated with neuropsychological performance in HIV - seropositive subjects without AIDS. Psychol Med. 2000; 30(1):205 – 17.
Valcour VG. HIV, aging, and cognition: Emerging issues. Top Antivir Med. 2013; 21(3):119 – 23.
Kabuba N, Anitha Menon J, Franklin DR, Lydersen S, Heaton RK, Hestad KA. Effect of age and level of education on neurocognitive impairment in HIV Positive Zambian adults. Neuropsychology. 2018; 32(5):519 – 28.
Ritchie SJ, Bates TC, Deary IJ. Is education associated with improvements in general cognitive ability, or in specific skills? Dev Psychol. 2015; 51(5):573 – 82.
Sanmarti M, Ibáñez L, Huertas S, Badenes D, Dalmau D, Slevin M, et al . HIV - associated neurocognitive disorders. J Mol Psychiatry. 2014; 2(1):2.
Liner KJ, Hall CD, Robertson KR. Effects of antiretroviral therapy on cognitive impairment. Vol. 5, Current HIV/AIDS Reports. Curr HIV/AIDS Rep; 2008 ; 64 – 71.
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