Publication Abstract Display
Type: Published Abstract
Title: Neurocognitive impairment and HIV infection in Nigeria: functional and virologic correlates.
Authors: Royal W, Akomolafe R, Habib A, Carr J, Cherner M, Chaurat M, Akinwande O, Johnson J, Grant I, Blattner W
Year: 2010
Publication: 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA
Volume: Issue: Pages: 421
Abstract:Background: In Nigeria the incidence and prevalence of HIV-related neurocognitive impairment and the rates of response to treatment are unknown. Therefore studies were performed in Nigeria to examine the potential utility of applying an established neuropsychological screening battery and detailed neuropsychological testing to detect neurocognitive impairment and correlations with functional impairment and the presence of specific viral signatures among infected subjects. Methods: The International HIV Dementia Scale (IHDS) was administered to 60 HIV-1-seropositive ART-naive individuals and 56 seronegative controls; in addition, participants were assessed for functional impairment using the Karnofsky Performance Status Scale. A detailed neuropsychological battery was administered to 15 HIV-infected patients and 11 controls. Blood samples from 8 infected subjects, 3 with evidence of neurocognitive impairment, were obtained for molecular analysis of HIV-1 strain, of which subtypes A and G and circulating recombinant forms of these subtypes are the most common HIV-1 strains in Nigeria. Results: Unadjusted scores on the IHDS showed that, using a recommended total score cutoff of 10, 28.8% of the HIV-1-seropositive and 16.0% of seropositive individuals scored abnormally. The mean Karnofsky score for the HIV-seropositive and -seronegative groups were, respectively, 90.7±12.2 and 98.8±3.8 (P <0.0001). Using a Karnofsky score of 50 as the gold standard, the IHDS had a greater sensitivity and specificity in predicting functional impairment when a total score cutoff of 9 was used than what was observed at a cutoff of 10. Results from testing using the full neuropsychological battery showed that overall the HIV-seropositive group performed worse than the seronegative group, with effect sizes spanning from small (0.25 on the Trail Making Test A) to large (0.82 on Action Fluency), with an average effect size across the battery of 0.45, which approaches that which has been recorded in other international settings. Finally, sequencing of partial pol and partial env amplicons from viral isolates revealed that 2 of the 3 patients with neurocognitive impairment were infected with subtype G virus and 1 with the circulating recombinant form (CRF) 02_AG; all 4 individuals without neurocognitive impairment were infected with CRF_02AG. Conclusions: These studies demonstrate the utility of conducting these studies for establishing the burden of neurocognitive impairment in the population of individuals with HIV-1 infection in Nigeria and for assessing the functional consequences and the virologic correlates of neurocognitive impairment.

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