DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174479

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

Neeraj Balaini, Ashima Sharma, Sudhi Sharma, Ashok Sharma

Abstract


Background: The main objective of the present work was to study the neurocognitive dysfunction in HIV positive patients and to determine its relation with CD4 count. Further, an attempt has also been made to study the relationship of neurocognitive dysfunction with cART regimen.

Methods: The study was a prospective observational study, conducted over a period of one year (from July 2012 to June 2013) in the Department of Medicine in collaboration with the Department of Psychiatry at Indira Gandhi Medical College and Hospital, Shimla.

Results: HIV associated neurocognitive dysfunction (HAND) was found in 39.04% patients. Mean duration from diagnosis of HIV to detection of HAND was 3.77 ± 1.7 years. Mean nadir CD4 cell count was 126.1/mm3. 39.04% patients (n=41) were found to have HIV associated neurocognitive disorder out of 105 screened patients. 95.1% patients (n=39) had asymptomatic neurocognitive impairement, 4.9% patients (n=2) had mild cognitive impairment and 2.08% patients (n=1) had HIV associated dementia. Out of 41 patients having HIV associated neurocognitive disorder, 68.3% patients (n=28) were having CD4 count less than 150. Those having CD4 count less than 150/mm3 had scored less on dementia scales indicating severe disease. 31.7% patients (n=13) were having HIV associated neurocognitive disorder (HAND) and CD4 count was more than 150/mm3.

Conclusions: The conclusion of the study is that HIV associated neurocognitive disorder is common and asymptomatic neurocognitive impairement is the commonest type of HIV associated neurocognitive disorder in HIV positive patients. It can be detected while patient is asymptomatic with help of simple neurocognitive tests. Although few studies reported higher prevalence of HIV associated neurocognitive disorder among patients on certain combined antiretroviral therapy (cART) regimen but our study didn’t indicate any such association.


Keywords


Antiretroviral therapy, CD4 count, Neurocognitive dysfunction

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References


Longo DL, Kasper DL, Jameson JL, Fauci AS., Hauser SL, Loscalzo J. et al. Harrison’s Principles of Internal Medicine.18th ed. Mc Graw Hill; 2012:1519-26.

Serena S. HIV and neurocognitive dysfunction. Curr HIV/AIDS Rep. 2013;10:235-43.

Walter R, Diana L. HIV associated dementia: Medlink Neurology; 1994. Available from http://www.medlink.com/ medlinkcontent.asp.

Antinori A, Arendt G, Becker JT, Brew BJ, Byrd D. A, Cherner M. et al. Updated research nosology for HIV-associated neurocognitive disorders, J. Neurol. 2007;69;1789-99.

Bhaskaran K, Mussini C, Antinori A. Changes in the incidence and predictors of human immunodeficiency virus-associated dementia in the era of highly active antiretroviral therapy. Ann Neurol. 2008;63:213.

Dore GJ, Correll PK, Li Y. Changes to AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS. 1999;13:1249.

Gupta JD, Satishchandra P, Gopukumar K, Wilkie F, Waldrop-Valverde D, Ellis R. et al. Neuropsychological deficits in human immunodeficiency virus type 1 clade C-seropositive adults from South India. J Neurovirol. 2007;13(3):195-202.

Heaton RK, Clifford DB, Franklin DR, Woods SP, Ake C, Vaida F, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: Charter Study. Neurol. 2010; 75(23):2087-96.

Wong MH, Robertson K, Nakasujja N. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology. 2007; 68(5):350-5.

Vijay D, Rani ST, Vemu L. Neurologic Manifestations of HIV Infection: An Indian Hospital-Based Study AIDS Read. 2005;15(3):139-45.

Yepthomi T, Paul R, Vallabhaneni S, Kumarasamy N, Tate DF, Solomon S, et al. Neurocognitive consequences of HIV in southern India: a preliminary study of clade C virus. J Int Neuropsychol Soc. 2006;12(3):424-30.

Krathwohl MD, Kaiser JL. HIV-1 promotes quiescence in human neural progenitor cells. J Infect Dis. 2004;190:216.

Moroni M, Antinori S. HIV and direct damage of organs: disease spectrum before and during the highly active antiretroviral therapy era. AIDS. 2003; 17 Suppl 1:S51.

Masliah E, DeTeresa RM, Mallory ME, Hansen LA. Changes in pathological findings at autopsy in AIDS cases for the last 15 years. AIDS 2000;14:69.

Levy RM, Bredesen DE. Central nervous system dysfunction in acquired immunodeficiency syndrome. J Acquir Immune Defic Syndr. 1988; 1(1):41-64.

Himachal Pradesh State AIDS Control Society. Available from http://hpsacs.org/aids.asp.

Buonaguro L, Tornesello ML, Buonaguro FM. Human Immunodeficiency Virus Type 1 Subtype Distribution in the Worldwide Epidemic: Pathogenetic and Therapeutic Implications. Journal of virol. 2007, p. 10209-19.

Mungas D. "In-office mental status testing: a practical guide". Geriatrics. 1991;46(7):54-8.

Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. A Review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatr. 2007; 78(8):790-9.

Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S. et al. The international HIV dementia scale. AIDS. 2005;19(13):1367-74.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Americ Geriatr Societ. 2005;53(4):695-9.

McCombe JA, Vivithanaporn P, Gill MJ, Power C. Predictors of Symptomatic HIV-associated Neurocognitive Disorders in Universal Health Care. HIV Medicine. 2013;14(2):99-107.

Chan LG, Kandiah N, Chua A. HIV-associated neurocognitive disorders (HAND) in a South Asian population - contextual application of the 2007 criteria BMJ Open. 2012;2:e000662.

Tozzi V, Balestra P, Bellagamba R. Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors. J Acquir Immune Defic Syndr. 2007;45:174.

Vishwanath BM, Das V, Thippeswamy T. A clinical profile of 396 cases of symptomatic HIV infected patients. JAPI. 2003;52(3):1182.

Adhikari AK. Clinical spectrum of patients of HIV/AIDS. JAPI. 2003;51:1258.

Sircar AR. Clinical profile of AIDS: a study at a referral hospital. J Assoc Physicians India. 1998; 46(9):775-8.

Dolan S, Montagno A, Wilkie S, Aliabadi N, Sullivan M, Zahka N, et al. Neurocognitive function in HIV-infected patients with low weight and weight loss. J Acquir Immune Defic Syndr. 2003; 34(2):155-64.

Reidel D, Ghate M, Nene M, Paranjape R, Mehendale S, Bollinger R, et al. Study to assess the prevalence, nature and extent of cognitive impairment in people living with AIDS. Indian J psychiatry. 2012;54(2):149-53.

Wig N. Neurocognitive dysfunction and CD4 counts in HIV-infected individuals in South Asia. Poster Exhibition: The XV International AIDS Conference: Abstract no. MoPeB3260. 2016.

Marra CM, Zhao Y. Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. Aids. 2009; 23(11):1359-66.

Cross S, Önen N, Gase A, Overton ET, Ances BM. Identifying risk factors for HIV-associated neurocognitive disorders using the international HIV dementia scale. J Neuroimmune Pharmacol. 2013;8(5):1114-22.