A variety of neurocognitive disorders may develop in HIV patients at any point of ... impairment and mild neurocognitive disorders to HIV associated dementia.
Priyadarshni S1, Acchapa B.P2, Chowta M3 1Student Kasturba Medical College, 2Department of Internal Medicine, 3Department of Pharmacology
INTRODUCTION A variety of neurocognitive disorders may develop in HIV patients at any point of time during infection whether otherwise symptomatic or not. These HIV associated neurocognitive dysfunction (HAND) range from asymptomatic neurocognitive impairment and mild neurocognitive disorders to HIV associated dementia. The most severe form of impairment is HIV-associated dementia. With antiretroviral treatment, the frequency of dementia is decreased, but milder forms of impairment remain highly prevalent and increase with age. Reliance on clinical symptoms alone is likely to miss a substantial proportion of patients with HAND. Western literature reports prevalence of cognitive disorders in patients with retroviral disease as high as 50%. With the increase in age of HIV positive population due to effective antiretroviral therapy, prevalence rate of cognitive disorders is likely to be higher among older HIV positive patients. HIV associated neurocognitive dysfunction may now be the most common form of youngage dementia globally. Cognitive impairment may impact medication adherence which will be ultimately affecting morbidity and mortality. Hence it is important to detect it early and follow effective strategy to improve adherence in this set of patients. Also the pattern of neurocognitive dysfunction is not consistent across individuals and may be even less consistent across individuals from geographically different backgrounds.
AIMS To evaluate the neurocognitive disorder among asymptomatic HIV positive patients which may help us to derive effective therapeutic strategy to improve adherence and quality of life of people living with HIV/AIDS.
METHODS • This cross sectional, prospective study was conducted in a tertiary care hospital attached to a medical college that caters to a large number of HIV positive patients. • The study was approved by institutional ethics committee. • The study population for this analysis included asymptomatic HIV positive individuals diagnosed by Integrated Counseling and Testing Centre (ICTC). • HIV positive patients belonging to WHO staging 1 or 2 only were included in the study. • Patients were included in the study after obtaining their written informed consent. • Demographic details of the patients were collected from the patient records. • HIV positive patients who had central nervous system opportunistic infections were excluded from the study. • Data collection was done using a pre-tested standard questionnaire, the International HIV Dementia scale. • Sample size was calculated based on expected proportions of neurocognitive impairment among asymptomatic HIV patients and was assumed as 38% based on previous studies. The precision taken was 10% and confidence interval of 95% was considered. Power was 80% and the minimum sample size was 91%. Including the non-response error, the final sample size was 101. Sampling method was by convenient sampling. Statistical analysis: Data collected was analyzed using SPSS Version 11.5. Student ‘t’ test was used to analyze the categorical data and Chi square test was done to analyze qualitative data. A ‘p’ value less than 0.05 was taken as statistically significant.
Table1: Baseline characteristics of study population (n=101) Patients without HAND (n=10)
p value 0.06
Characteristics
All patients
Patients with HAND (n=91)
Age in years (mean ±SD)
42.81±9.32
43.40±9.02
37.50±10.84
69 (68.3)
66 (72.5)
3 (30)
Male n (%) Gender
0.006* Female n (%)
Duration of HIV infection in years
32 (31.7)
25 (27.5)
7 (70)
5.54±4.8
5.5407±4.86
5.5550±4.45
(mean ±SD) Baseline CD4 count cells /μL
0.99
237.48±207.13 220.96±193.09 384.33±277.09
0.02*
450.9±283.49
0.08
(mean ±SD) Current CD4 count cells /μL
434.54±286.12 599.80±216.73
(mean ±SD) Receiving ART
yes
88 (87.1)
n (%)
no
13 (12.9)
10 (76.1)
3 (23.9)
WHO stage
1
84 (83.2)
75 (89.3)
9 (10.7)
n (%)
2
17 (16.8)
16 (94.1)
1 (5.9)
1 (Illiterate)
30 (29.7)
30 (33)
0 (0)
2 (Primary)
26 (25.7)
21(23.1)
5(50)
3 (Secondary)
30 (29.7)
27 (29.7)
3 (30)
4 (>Secondary)
15 (14.9)
13(14.2)
2 (20)
Educational level n (%)
Student ‘t’ & x2 tests, * significant
81 (92)
7 (8) 0.12
0.87
0.03*
HAND =HIV associated neurological dysfunction
Table 2: Distribution of patients based on age group stratified by cognitive diagnosis Patients with HAND
