From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
Neurology. 2020 Nov 10;95(19):e2610-e2621. doi: 10.1212/WNL.0000000000010752. Epub 2020 Sep 4.
To characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.
We searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.
Of 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7-45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3-26.8), 13.3% (10.6-16.3), and 5.0% (3.5-6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5-49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7-41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300-17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000-13,568,000).
Our findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.
描述 HIV 相关神经认知障碍（HAND）的流行率和负担，并评估全球 HIV 感染者中HAND 及其亚型的相关因素。
我们检索了 1996 年 1 月 1 日至 2020 年 5 月 15 日期间发表的关于 HIV 成人感染者 HAND 流行率或其亚型的横断面或队列研究，未对语言进行限制，然后使用 PubMed 和 Embase 进行检索。两名评审员独立进行研究选择、数据提取和质量评估。我们采用随机效应模型估计 HAND 的汇总流行率，并评估其在全球范围内的总体负担。
在 5588 条记录中，我们纳入了来自 32 个国家的 123 项研究，共涉及 35513 名参与者。HAND 的总体流行率为 42.6%（95%置信区间[CI]39.7-45.5），且与所使用的诊断标准无关。根据 Frascati 标准，无症状性神经认知障碍、轻度神经认知障碍和 HIV 相关痴呆的流行率分别为 23.5%（20.3-26.8）、13.3%（10.6-16.3）和 5.0%（3.5-6.8）。HAND 的流行率与 CD4 最低点水平显著相关，CD4 最低点较低组（CD4 最低点＜200 个/mm3 的患者，45.2%[40.5-49.9]）HAND 的流行率明显高于 CD4 最低点较高组（CD4 最低点≥200 个/mm3 的患者，37.1%[32.7-41.7]）。我们估计，全球范围内约有 1614.54 万例（95%CI 1504.63 万例-1724.45 万例）HIV 感染者患有 HAND，其中 72%（1157.12 万例，95%CI 960 万例-1356.8 万例）来自撒哈拉以南非洲地区。
我们的研究结果表明，在抗逆转录病毒治疗（ART）时代，HIV 感染者 HAND 的负担很高，尤其是在撒哈拉以南非洲地区和拉丁美洲地区。早期开始 ART 并持续坚持治疗以维持高水平的 CD4 细胞计数并防止严重免疫抑制，可能会降低 HAND 的流行率和严重程度。
