Mogambery Jade C, Dawood Halima, Wilson Douglas, Moodley Anand
Department of Internal Medicine, Ngwelezana Hospital, University of KwaZulu-Natal, South Africa.
Department of Internal Medicine, Infectious Diseases Unit, Grey's Hospital, University of KwaZulu-Natal, South Africa.
South Afr J HIV Med. 2017 Sep 26;18(1):732. doi: 10.4102/sajhivmed.v18i1.732. eCollection 2017.
HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings.
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.
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.
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 ( = 0.003). There was no correlation between the GUGT, CESD-r and the IHDS score. HAND was not associated with non-adherence ( = 0.06).
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.
HIV 相关神经认知障碍（HAND）是中枢神经系统 HIV 感染的结果。在不同环境中，其患病率在 15%至 60%之间。
这项前瞻性研究确定了夸祖鲁 - 纳塔尔省一家城郊 HIV 诊所中 HAND 的患病率。研究了与 HAND 相关的因素，将替代神经认知工具与国际 HIV 痴呆量表（IHDS）评分进行了对比测试，并探讨了 HAND 与抗逆转录病毒疗法（ART）治疗依从性之间的关联。
2014 年 5 月至 2015 年 5 月期间，对 146 名未接受过 ART 的门诊患者进行了 HAND 评估。IHDS 评分≤10 确定为 HAND 诊断标准。使用东部肿瘤协作组（ECOG）评分评估功能能力。采用卡方检验确定 HAND 的危险因素。将起立行走测试（GUGT）和流行病学研究中心抑郁量表修订版（CESD - r）与 IHDS 进行对比测试。开始 ART 治疗六个月后的 HIV 病毒载量用作 ART 治疗依从性的替代指标。
HAND 的患病率为 53%。总体而言，99.9%的 HAND 患者无功能损害。年龄>50 岁与 HAND 相关（P = 0.003）。GUGT、CESD - r 与 IHDS 评分之间无相关性。HAND 与治疗不依从无关（P = 0.06）。
虽然 HAND 的患病率较高，但它与功能损害无关，这表明无症状神经认知障碍很普遍。年龄>50 岁是 HAND 的一个危险因素。GUGT 和 CESD - r 不是 HAND 的有用诊断工具。HAND 与治疗不依从之间的关系应进一步探讨。
