A multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings.

TitleA multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings.
Publication TypeJournal Article
Year of Publication2011
AuthorsRobertson K, Kumwenda J, Supparatpinyo K, Jiang JH, Evans S, Campbell TB, Price RW, Murphy R, Hall C, Marra CM, Marcus C, Berzins B, Masih R, Santos B, Silva MT, Kumarasamy N, Walawander A, Nair A, Tripathy S, Kanyama C, Hosseinipour M, Montano S, La Rosa A, Amod F, Sanne I, Firnhaber C, Hakim J, Brouwers P
Corporate AuthorsAIDS Clinical Trials Group
JournalJ Neurovirol
Volume17
Issue5
Pagination438-47
Date Published2011 Oct
ISSN1538-2443
KeywordsAdolescent, Adult, Africa South of the Sahara, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Asia, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Neuropsychological Tests, Polyneuropathies, Prevalence, Prospective Studies, Randomized Controlled Trials as Topic, South America, Young Adult
Abstract

Little is known about how the prevalence and incidence of neurological disease in HIV-infected patients in resource-limited settings. We present an analysis of neurological and neurocognitive function in antiretroviral naïve individuals in multinational resource-limited settings. This prospective multinational cohort study, a substudy of a large international randomized antiretroviral treatment trial, was conducted in seven low- and middle-income countries in sub-Saharan Africa, South America, and Asia. Subjects were HIV-infected and met regional criteria to initiate antiretroviral therapy. Standardized neurological examination and a brief motor-based neuropsychological examination were administered. A total of 860 subjects were studied. Overall 249 (29%) had one or more abnormalities on neurological examinations, but there was a low prevalence of HIV-associated dementia (HAD) and minor neurocognitive disorder (MND). Twenty percent of subjects had evidence of peripheral neuropathy. There were significant differences across countries (p < 0.001) in neuropsychological test performance. In this first multinational study of neurological function in antiretroviral naïve individuals in resource-limited settings, there was a substantial prevalence of peripheral neuropathy and low prevalence of dementia and other CNS diseases. There was significant variation in neurocognitive test performance and neurological examination findings across countries. These may reflect cultural differences, differences in HIV-related and unrelated diseases, and variations in test administration across sites. Longitudinal follow-up after antiretroviral treatment initiation may help to define more broadly the role of HIV in these differences as well as the impact of treatment on performance.

DOI10.1007/s13365-011-0044-3
Alternate JournalJ. Neurovirol.
PubMed ID21786076
PubMed Central IDPMC3362044
Grant List5 U01 AI069401 / AI / NIAID NIH HHS / United States
5U01 AI069438-03 / AI / NIAID NIH HHS / United States
5U01AI069417-03 / AI / NIAID NIH HHS / United States
5U01AI069426-03 / AI / NIAID NIH HHS / United States
AI-068634 / AI / NIAID NIH HHS / United States
AI069399 / AI / NIAID NIH HHS / United States
AI069463 / AI / NIAID NIH HHS / United States
AI069518 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01A1069518 / / PHS HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069417 / AI / NIAID NIH HHS / United States