Department of Psychiatry, College of Health Sciences, African Mental Health Research Initiative, University of Zimbabwe, Harare, Zimbabwe.
Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
BMC Infect Dis. 2020 May 29;20(1):383. doi: 10.1186/s12879-020-05090-8.
HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls.
Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning.
Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI.
NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.
HIV 会影响中枢神经系统，导致约 50%的 HIV 感染者出现与 HIV 相关的认知障碍（NCI）。它通常会影响记忆、学习、工作记忆、精细运动技能、信息处理速度、词汇流畅性和执行功能等认知领域。NCI 会影响抗逆转录病毒治疗（ART）的依从性、就业能力、驾驶能力和日常生活活动。津巴布韦没有常规筛查 NCI，在这种环境下，其负担也不为人知。本研究的目的是：1）使用哈拉雷两家初级保健诊所的综合神经心理学测试来确定 NCI 的患病率；2）使用金标准神经心理学（NP）测试评估 HIV 阳性患者与 HIV 阴性对照组之间认知障碍的模式。
纳入标准：18 岁或以上；最低 7 年教育；无神经或精神障碍。HIV 阳性参与者已接受 ART 治疗≥3 个月；HIV 阴性参与者在过去一个月内确认 HIV 阴性。对参与者进行综合 NP 测试、功能评估、人口统计学和医学史问卷。NP 测试包括评估记忆、学习、工作记忆、精细运动技能、信息处理速度、词汇流畅性和执行功能的测试。
共招募了 231 名参与者。其中，155 名为 HIV 阳性（女性=70%，年龄 M=37.8；SD 11.2），76 名为 HIV 阴性（女性=63%，年龄 M=31.2；SD 9.9）。HIV 阳性参与者接受 ART 治疗的平均时间为 6 年。49.7%的 HIV 阳性参与者存在 NCI。与 HIV 阴性参与者相比，HIV 阳性组在 7 个认知领域中的 5 个领域的得分明显更差。较高的教育水平与 NCI 呈负相关。
津巴布韦 HIV 阳性人群中的 NCI 患病率与全球估计一致。在接受 ART 治疗的成年人中，NCI 仍然存在。因此，在初级保健诊所使用这种改编后的测试对成年人进行常规 NCI 评估非常重要，以便早期发现并提供必要的干预措施。
