Abstract
The HIV/AIDS epidemic is now in its fourth decade in Sub-Saharan Africa where survival of HIV infected individuals has resulted in an increased burden of cognitive impairment among People Living With HIV/AIDS. The greatest risk for the impairment has been among those who are older and of female gender. Various categories of cognitive impairment are now more recognised as affecting the HIV population. The classification for the impairment currently follows the Frascati criteria that subgroups the HIV-Associated Neurocognitive Disorders (HAND) into: HIV Associated Asymptomatic Neurocognitive Impairment (ANI), HIV-1 Associated Mild Neurocognitive Disorder (MND) and HIV 1 Associated Dementia (HAD).
Using cross cultural neuropsychological tools, it has been possible to have screening instruments for detection of possible cases of HIV-associated cognitive impairment that are then further evaluated for confirmation specific impairment.
Among untreated patients with HIV dementia there is a close association with the inflammatory response and cerebral spinal fluid viral load. With the exception of combination antiretroviral therapy, no adjuvant treatments including drugs like minocycline have proven to be effective in reversing HIV-associated neurocognitive impairment.
As long as there is continued limitation on the availability of ART in sub-Saharan Africa, HAND will continue to cause significant HIV-related neurocognitive problems in SSA where the highest HIV infection burden occurs.
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References
Clifford B, Ances B. HIV-associated neurocognitive disorder. Lancet Infect Dis. 2013;13:976–86.
Sacktor N, Nakasujja N, Skolasky R, Robertson K, Wong M, Musisi S, Katabira E, Ronald A. Antiretroviral therapy improves cognitive impairment in HIV+ individuals in sub-Saharan Africa. Neurology. 2006;67(2):311–4.
Sacktor N, Nakasujja N, Redd A, Manucci J, Laeyendecker O, Wendel S, Porcella S, Martens C, Bruno D, Skolasky R, Okonkwo O, Robertson K, Musisi S, Katabira E, Quinn THJ. HIV subtype is not associated with dementia among individuals with moderate and advanced immunosuppression in Kampala, Uganda. Metab Brain Dis. 2014;29(2):261–8.
Letendre S, Marquie-Beck J, Capparelli E, Best B, Clifford D, Collier A, Gelman B, McArthur J, McCutchan J, Morgello S, Simpson D, Grant I, Ellis R, CHARTER Group. Validation of the CNS penetration-effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol. 2008;65(1):65–70.
Navia B, Jordan B, Price R. The AIDS dementia complex: I. Clinical features. Ann Neurol. 1986;19:517–24.
Sacktor N, Nakasujja N, Okonkwo O, Skolasky R, Robertson K, Musisi S, Katabira EJNJ. Longitudinal neuropsychological test performance among HIV seropositive individuals in Uganda. J Neurovirol. 2013;19(1):48–56.
Nakasujja N, Miyahara S, Evans S, Lee A, Musisi S, Katabira E, Robertson K, Ronald A, Clifford D, Sacktor N. Randomized trial of minocycline in the treatment of HIV-associated cognitive impairment. Neurology. 2013;80:196–202.
Lucas M, Karrer U, Lucas A, Klenerman P. Viral escape mechanisms–escapology taught by viruses. Int J Exp Pathol. 2001;82(5):269–86.
Antinori A, Arendt G, Becker J, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789–99.
Robertson KR, Nakasujja N, Musisi S, Wong M, Katabira E, Parsons T, Ronald A, Sacktor N. Pattern of neuropsychological performance among HIV positive patients in Uganda. BMC Neurol 2007;7:8.
Wong M, Robertson K, Nakasujja N, Skolasky R, Musisi S, Katabira E, Ronald A, Sacktor N, et al. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology. 2007;68:350–5.
Georgette K, Kuate C, Cysique L, Fonsah J, Eta S, Doh R, Njamnshi D, Nchindap E, Franklin D, Ellis R, McCutchan J, Binam F, Mbanya D, Heaton R, Njamnshi A. HIV – associated neurocognitive disorders in sub-Saharan Africa: a pilot study in Cameroon. BMC Neurol. 2010;10:60.
Atashili J, Gaynes B, Pence B, Tayong G, Kats D, O’donnell J, Ndumbe P, Njamnshi A. Prevalence, characteristics and correlates of a positive-dementia screen in patients on antiretroviral therapy in Bamenda, Cameroon: a cross-sectional study. BMC Neurol. 2013;13:86.
Sacktor N, Wong M, Nakasujja N, Skolasky R, Selnes O, Musisi S, Ronald A, Katabira E, Robertson K. The international HIV dementia scale: a new rapid screening test for HIV dementia. AIDS. 2005;19(13):1367–74.
Joska JA, Westgarth-Taylor J, Hoare J, Thomas KG, Paul R, Myer L, Stein DJ. Validity of the international HIV dementia scale in South Africa. AIDS Patient Care STDS. 2011;25(2):95–101.
Gisslén M, Price R, Nilsson S. The definition of HIV-associated neurocognitive disorders: are we overestimating the real prevalence? BMC Infect Dis. 2011;11:356.
Heaton R, Franklin D, Ellis RJ, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17:3–16.
Cooper E, Lacey C. Laboratory indices of prognosis in HIV infection. Biomed Pharmacother. 1988;42(8):539–45.
McMcArthur J, Nance-Sproson T, Griffin D. The diagnostic utility of elevation in cerebrospinal fluid β2-microglobulin in HIV-1 dementia. Neurology. 1992;42:1707–12.
González-Scarano F, MartÃn-GarcÃa J. The neuropathogenesis of AIDS. Review. Nat Rev Immunol. 2005;5(1):69–81.
Nakasujja N, Skolasky R, Musisi S, Allebeck P, Robertson K, Ronald A, Katabira E, Clifford B, Sacktor N . Depression symptoms and cognitive function among individuals with advanced HIV-infection in Uganda. BMC Psychiatry. 2010;10:44.
Sacktor N, Nakasujja N, Skolasky R, Rezapour M, Robertson K, Laeyendeker O, Musisi S, Katabira E, Quinn T. HIV subtype D is associated with dementia compared with subtype a in immuno-suppressed individuals at risk of cognitive impairment in Kampala, Uganda. Clin Infect Dis. 2009;49(5):780–6.
Nakasujja N, Allebeck P, Agren H, Musisi S, Katabira E. Cognitive dysfunction among HIV positive and HIV negative patients with psychosis in Uganda. PLoS One. 2012;7(9):e44415.
Carlson R, Rolfes M, Birkenkamp K, Nakasujja N, Rajasingham R, Meya D, Boulware D. Predictors of neurocognitive outcomes on antiretroviral therapy after cryptococcal meningitis: a prospective cohort study. Metab Brain Dis. 2014;29(2):269–79.
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Nakasujja, N. (2015). HIV-Associated Cognitive Impairment in Sub-Saharan Africa. In: Musisi, S., Jacobson, S. (eds) Brain Degeneration and Dementia in Sub-Saharan Africa. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2456-1_4
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DOI: https://doi.org/10.1007/978-1-4939-2456-1_4
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