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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
HIV Associated Neurocognitive Disorders (HAND) in Malawian adults and effect on adherence to combination anti-retroviral therapy: A cross sectional study
PLoS ONE, Volume 9, No. 6, Article e98962, Year 2014
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Description
Background: Little is known about the prevalence and burden of HIV associated neurocognitive disorder (HAND) among patients on combination antiretroviral therapy (cART) in sub-Saharan Africa. We estimated the prevalence of HAND in adult Malawians on cART and investigated the relationship between HAND and adherence to cART. Methods: HIV positive adults in Blantyre, Malawi underwent a full medical history, neurocognitive test battery, depression score, Karnofsky Performance Score and adherence assessment. The Frascati criteria were used to diagnose HAND and the Global Deficit Score (GDS) was also assessed. Blood was drawn for CD4 count and plasma nevirapine and efavirenz concentrations. HIV negative adults were recruited from the HIV testing clinic to provide normative scores for the neurocognitive battery. Results: One hundred and six HIV positive patients, with median (range) age 39 (18-71) years, 73% female and median (range) CD4 count 323.5 (68-1039) cells/m l were studied. Symptomatic neurocognitive impairment was present in 15% (12% mild neurocognitive disorder [MND], 3% HIV associated dementia [HAD]). A further 55% fulfilled Frascati criteria for asymptomatic neurocognitive impairment (ANI); however factors other than neurocognitive impairment could have confounded this estimate. Neither the symptomatic (MND and HAD) nor asymptomatic (ANI) forms of HAND were associated with subtherapeutic nevirapine/efavirenz concentrations, adjusted odds ratio 1.44 (CI. 0.234, 8.798; p = 0.696) and aOR 0.577 (CI. 0.09, 3.605; p = 0.556) respectively. All patients with subtherapeutic nevirapine/efavirenz levels had a GDS of less than 0.6, consistent with normal neurocognition. Discussion/Conclusion: Fifteen percent of adult Malawians on cART had a diagnosis of MND or HAD. Subtherapeutic drug concentrations were found exclusively in patients with normal neurocognitive function suggesting HAND did not affect cART adherence. Further study of HAND requires more robust locally derived normative neurocognitive values and determination of the clinical relevance of ANI. © 2014 Kelly et al.
Authors & Co-Authors
Kelly, Christine M.
United Kingdom, Liverpool
University of Liverpool
Malawi, Zomba
University of Malawi
van Oosterhout, Joep J.G.
Malawi, Zomba
University of Malawi
Canada, Toronto
Dignitas International
Ngwalo, Chisomo
Malawi, Zomba
University of Malawi
Stewart, Robert C.
Malawi, Zomba
University of Malawi
Benjamin, Laura A.
United Kingdom, Liverpool
University of Liverpool
Robertson, Kevin R.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Khoo, Saye Hock
United Kingdom, Liverpool
University of Liverpool
Allain, Theresa Jane
Malawi, Zomba
University of Malawi
Solomon, Tom
United Kingdom, Liverpool
University of Liverpool
United Kingdom, Liverpool
The Walton Centre Nhs Foundation Trust
United Kingdom, Liverpool
Nihr Health Protection Research Unit in Emerging and Zoonotic Infections
Statistics
Citations: 58
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0098962
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Mental Health
Study Design
Cross Sectional Study
Case-Control Study
Study Locations
Malawi
Participants Gender
Female