Table 3.
Overview of studies on HIV-related dementia and risk factors in sub-Saharan
| Author, year of publication | Country/setting | Design/study period | Population characteristics | Diagnostic criteria | Prevalence | Risk factors | Comments |
|---|---|---|---|---|---|---|---|
| Belec
[77], 1989 |
Central African republic, Hospital |
Cross-sectional 1987 |
93 HIV + participants; age and sex not specified |
Not reported |
HAND: 3 cases (3.2%) |
NA |
No neuro-imaging or neuropathological studies |
| Howlet
[78], 1989 |
Tanzania, hospital |
Cross-sectional 1985-1988 |
200 (men 129) HIV + participants; mean age: 32 y |
Decline of memory and other functions |
Dementia complex: 54% |
NA |
|
| Turnbull
[79], 1991 |
South Africa |
Cross-sectional 1982-1983 |
27 haemophilic patients with HIV infection |
Battery of neuropsychological tests: Rey complex figure, Babcock story, digit span, WAIS |
HAND: 4 cases (14.8%) |
NA |
|
| Perriëns
[80], 1992 |
Democratic republic of Congo Hospital |
Cross sectional 2008 |
104 (men 48) HIV + participants; mean age: 34.3 y.; 92 (men 53) HIV- participants; mean age 44 y 9 (men 5) HIV + with HAND |
WHO operational criteria/American Academy of neurology criteria |
HIV Associated |Dementia Complex. 8.7% |
NA |
No neuro-imaging study |
| Maj
[81], 1994 |
Kenya Hospital |
Cross sectional 1990-1991 |
65 (men 49) HIV- participants; mean age: 30 y.; 66 (men 42) asymptomatic HIV + participants; mean age 30.7; 72 (men 48) symptomatic HIV + participants; mean age: 33.2 y |
ICD-10/DSM-IV |
Dementia HIV- 0 Asymptomatic HIV + 0 Symptomatic HIV + 6 (%) |
NA |
|
| Democratic republic of Congo Hospital |
85 ( men 48) HIV- participants; mean age: 33.9 y; 52 (men 33) asymptomatic HIV + participants; mean age 32.3 y.; 68 (men 35) symptomatic HIV + participants; mean age: 33.8 y |
ICD-10/DSM-IV |
Dementia HIV- 0 Asymptomatic HIV + 0 Symptomatic HIV + (5.9%) |
NA |
|
||
| Carson
[82], 1998 |
Kenya |
Cross sectional |
78 (men 52) HIV + participants; mean age: 29.9 y.; 138 (men 114) HIV- participants; mean age 29.8 y. |
Revised WAIS, Trails A and Trails B tests, Digit span, Delayed word and d recognition |
NA |
NA |
No difference in neuropsychiatric test performance between HIV + and HIV- |
| Hospital |
1994 |
||||||
| Sebit
[83], 1995 |
Kenya |
Cross sectional |
191 participants, 72 (men 48) symptomatic HIV + (mean age 33.2 y.), 66 (men 42) asymptomatic HIV + (mean age 30.7) and 65 (men 49) HIV- (mean age 30 y.) |
WHO operational criteria/American Academy of neurology criteria |
Mental disorders: |
NA |
No specific data for HIV associated neurocognitive disorders |
| Hospital | |||||||
| 1990-1991 | |||||||
| Symptomatic HIV + 7.1%, Asymptomatic HIV + 4.5%, HIV -0 | |||||||
| Democratic republic of Congo (DRC)/Hospital |
190 participants, 68 (men 35) symptomatic HIV + (mean age 33.8 y.), 52 (men 33) asymptomatic HIV + (mean age 32.3) and 85 (men 48) HIV- (mean age: 33.9 y.) |
WHO operational criteria/American Academy of neurology criteria |
Mental disorders: |
NA |
No specific data for HIV associated neurocognitive disorders |
||
| symptomatic HIV + 5.9%, asymptomatic HIV + 1.9%, HIV– 1.2% | |||||||
| Sacktor
[84], 2006 |
Uganda, Hospital |
Prospective |
23 (men 5) HIV + participants on |
MSK HIV dementia scale IHDS |
Baseline: Subclinical dementia 35% |
NA |
All participants had CD4 count ≤200 cells/mL and an IHDS ≤ 10 (suggestive of HAND) |
| Cohort study | |||||||
| 2004-2005 | |||||||
| HAART (mean age 32.8 y.) | |||||||
| Re-assessment at 3 and 6 months. | |||||||
| Mild dementia 61% | |||||||
| At 3 (6) months: mild dementia 26% (4%) | |||||||
| Sacktor
[85], 2005 |
Uganda, Hospital |
Cross-sectional 2003-2004 |
81 HIV+; mean age: 37 y.; 100 HIV- mean age: 31.4 y; 21 had HIV dementia |
IHDS (cut off ≤10), |
HIV dementia: 31% |
NA |
|
| MSK HIV dementia scale | |||||||
| Modi
[86], 2007 |
South-Africa, Hospital |
Cross-sectional |
506 HIV + (men 203) on HAART; mean age/range: 37 years 193 had HIV associated dementia |
American Academy of Neurology AIDS Task force |
HIV dementia: 38% |
NA |
75% had CD4 below 100 cells/mm3 |
| 2005 | |||||||
| Clifford
[87], 2007 |
Ethiopia, Hospital |
Case–control |
73 (men 67%) HIV + participants (median age 39 y.); |
IHDS |
NA |
NA |
Quantitative neuropsychiatric tests - no difference between groups |
| 2004 | |||||||
| 87 (men 63%) HIV- participants (median age 38 y.) | |||||||
| Odiase
[88], 2007 |
Nigeria, Hospital |
case–control |
96 (men 48) symptomatic HIV + patients (mean age 33.6 y.), |
FePsy computerized neuropsychological test battery |
NA |
NA |
Severity of immune suppression predictive of cognitive decline |
| 2004 | |||||||
| 96 (men 48) asymptomatic HIV + (mean age 31.5 y.); 96 (men 48) HIV- (mean age 32.9 y.) | |||||||
| Wong
[89], 2007 |
Uganda, Hospital |
Cross-sectional |
78 (men 28) HIV + participants (mean age 37 y.); 24 (men 6) with dementia; 100 HIV – participants |
MSK HIV dementia scale |
HIV dementia. 31% |
Age, low CD4 count associated HIV dementia |
|
| 2003-2004 | |||||||
| Robertson
[90], 2007 |
Uganda, Hospital |
Cross-sectional |
110 (men 34) HIV + participants (WHO Stage 2/3/4, n = 21/69/20); mean age 36.7 y.; 49 on HAART |
MSK HIV dementia scale |
NA |
NA |
Pattern of neuropsychological deficits similar to that in western countries. |
| 2003-2004 | |||||||
| 100 (men 60) HIV– controls (mean age 27.5 y.) | |||||||
| Salawu
[91], 2008 |
Nigeria, hospital |
Cross-sectional |
60 HIV + (men 24), asymptomatic, naïve of HAART; mean age 32 y) |
CSID |
56.7% |
No correlation between CD4 count and performance on neuropsychological testing |
|
| 60 HIV- (men 24); mean age: 30.1 y; | |||||||
| 34 had HIV dementia | |||||||
| Singh
[92], 2008 |
South Africa, Hospital |
Cross-sectional |
20 HIV + (men 8) participants; median age 34 y |
IHDS-criteria (cut-off ≤10) |
HAND: 80% |
NA |
CD4 < 200 cells/mm3, older than 18 years and not be delirious. |
| 2007 |
16 had HAND |
||||||
| Säll
[93], 2009 |
South Africa, Hospital |
Retrospective |
38 HIV + admitted to the psychiatric ward with psychiatric symptoms; mmean age 32.4 y |
DSM-IV |
Dementia: 32% |
NA |
|
| 1987-1997 | |||||||
| 12 had dementia | |||||||
| Ganasen
[94], 2008 |
South Africa, Hospital |
Cross-sectional |
474 (men 123) HIV + patients (328 blacks and 135 coloured); mean age 34 y. |
HIV dementia scale |
HAND: 17.1% (IHDS) and 2.3% (MMSE) |
NA |
|
| MMSE | |||||||
| Njamnshi
[95], 2008 |
Cameroon, Hospital |
Case–control study 2006 |
204 (men 64) HIV + participants (mean age 37.2 y.); 204 (men 64) HIV- participants (mean age 37.1 y.) |
IHDS-criteria (cut-off ≤10) |
HAND: |
NA |
|
| HIV+: 21.1% | |||||||
| HIV-: 2.5% | |||||||
| Sacktor
[96], 2009 |
Uganda, Hospital |
Prospective cohort |
102 (men 29) HIV + never treated patients (mean age 34.2 y.) started on Stavudine-based HAART |
IHDS criteria |
Base line: 40% had HIV dementia (33% mild, 7% moderate) |
NA |
|
| MSK HIV dementia scale | |||||||
| 2005-2007 | |||||||
| Follow-up 6 months | |||||||
| 25 (men 15) HIV- (mean age 30.3 y.) | |||||||
| At 3 months: 26%, 23% mild, 3% moderate | |||||||
| At 6 months: 16% (13% mild, 3% moderate | |||||||
| Njamnshi
[97], 2009 |
Cameroon, Hospital |
Cross-sectional |
185 (men 61) HIV + participants (mean age 37 y.); 41 with possible HAND (mean age 37y.) |
IHDS-criteria |
HAND: 22. 2% |
Advanced clinical stage, low CD4 count, and low haemoglobin levels |
|
| 2006 | |||||||
| Sacktor
[98], 2009 |
Uganda, |
Cross-sectional |
60 HIV + never treated participants; 22 with dementia |
IHDS criteria |
Overall: 36.7% |
HIV subtype D associated with increased risk of HIV dementia |
All participants had CD4, count ≤200 cells/mL and an IHDS ≤ 10 (suggestive of HAND) |
| Hospital | |||||||
| 2005-2007 | |||||||
| MSK HIV dementia scale | |||||||
| Nakasujja
[99], 2010 |
Uganda, |
Prospective cohort |
102 HIV + (men 28); mean age: 34.2 y; 70 with cognitive impairment at baseline |
IHDS (cut-off ≤10) |
Base line: 68.6% |
NA |
|
| Hospital | |||||||
| 2005-2007 | |||||||
| neuropsychological tests and MSK HIV dementia scale |
At 3 months: 36% |
||||||
| At 6 months: 30% | |||||||
| Kinyanda
[100], 2011 |
Uganda, |
Cross-sectional |
618 HIV + (men 169), 83% <45 y |
IHDS (cut-off ≤ 10) |
64% |
|
|
| 396 had cognitive disorders | |||||||
| Hospital |
2010 |
||||||
| Choi
[101], 2011 |
Guinea Bissau, |
Case–control |
22 HIV-2 + (men 4)participants mean age for those with CD4 < 350 = 55.1 y, mean age for those with CD4 ≥ 350 = 50.3 y) |
IHDS |
HIV+: 22.7% (CD4 < 350 = 27%, CD4 ≥ 350 = 18%) |
age (β = -0.11) |
|
| Hospital | |||||||
| 45 HIV- controls (men 1); mean age51 · 9 y) |
MSK HIV dementia scale |
||||||
| Control: 11% | |||||||
| Birbeck
[102], 2011 |
Zambia,, |
Cross-sectional |
496 HIV + (men 205) participants screened within 1 week of initiating ART; mean age 38.1 y) |
I\HDS (cutt-off ≤ 10) |
42.1% (IHDS) |
NA |
Low IHDS score was associated with poor adherence to HAART |
| Hospital |
2006-2007 |
||||||
| MMSE (<=22) |
34.4% (zMMSE) |
||||||
| IHDS administered to 440 participants. | |||||||
| 185 had dementia | |||||||
| Joska
[103], 2010 |
South Africa, Hospital |
Cross-sectional |
536 (men 26.7%) HIV + participants (68% blacks, 28% coloured), mean age 34 y. |
HDS (cutt-off ≤ 10) |
HAND: 23.5% |
Age, education, diagnosed duration, post-traumatic stress disorder |
IDHS not yet available by the time of the study |
| Kanmogne
[104], 2010 |
Cameroon |
Case–control |
43 (men 18) HIV- participants (mean age 33.3 y.); 44 (men 17) HIV + participants (mean age 34.9 y.); 22 with AIDs defining conditions, 34% on HAART |
HIV Neurobehavioral Research Center International neuropsychological test battery |
NA |
NA |
|
| Hospital | |||||||
| 2008-2009 | |||||||
| Lawler
[105], 2010 |
Botswana, |
Cross-sectional |
120 (men 60) HIV + patients (mean age 37.5 y.); 97.5% on HAART; |
IHDS-criteria (cut-off ≤9.5) |
HAND: 38% |
NA |
|
| 2008 |
46 with HIV dementia |
||||||
| Hospital | |||||||
| Patel
[106], 2010 |
Malawi, Hospital |
Cross sectional |
179 (men 63) HIV + participants (mean age 36.7 y.); Stage III/IV 90%; 134 on HAART > 6 months; |
IHDS-criteria (cut-off ≤10) |
HAD |
Female gender, low education |
|
| 2007 | |||||||
| 25 (men 14) with HIV dementia | |||||||
| Overall: 14% | |||||||
| Men: 22.2% | |||||||
| Women: 9.5% | |||||||
| Siddiqi
[69], 2009 |
Zambia |
Cross-sectional |
443 (men 219) inpatients (median age 39 y., 67 HIV+); 368 (men 168) outpatients (median age 39 y., 58 HIV+); Overall 36 cases of dementia |
Not specified |
NA |
HIV+: 10.4% |
HIV + patient had a higher frequency of dementia and had dementia at younger age |
| Hospital | |||||||
| HIV-: 3.3% | |||||||
| Ekenze
[21], 2010 |
Nigeria, Hospital |
Cross-sectional |
8440 admissions; 1249 (men 640) with neurological diseases (mean age 45 y.); 44 (men 18) with AIDS dementia complex |
Not specified |
AIDS dementia complex: 3.5% of all neurological admission |
NA |
|
| 2003-2007 | |||||||
| Holguin
[107], 2011 |
Zambia, Hospital |
Case–control |
57 (men 30) HIV- participants (mean age 28 y.); 83 (men 32) HIV + (mean age 34 y.) including 54 naïve of HAART |
IHDS (cut-off ≤ 10) |
HAND = 22% among HIV + naïve of ARV |
NA |
|
| Color Trails Test 1 and | |||||||
| 2008 |
2, Grooved pegboard Test, and Time Gait Test |
||||||
| Joska
[108], 2011 |
South Africa, Hospital |
Case–control |
94 (men 36) HIV- participants (mean age 25.2 y); 96 (men 20) HIV + (mean age 29.8 y) |
IHDS |
NA |
Education associated with IHDS total score |
Validation study of the IHDS |
| 2008 | |||||||
| Obiabo
[109], 2011 |
Nigeria, |
Prospective Cohort study |
69 (men 25) HIV + participants with CD4 < 350 (mean age 36.2 y.); 30 (men 11) HIV- (mean age 36.6 y.) |
CSID and FePsy computerized neuropsychological test battery |
NA |
NA |
HAART improved neuropsychological performances after 12 months of treatment |
| Hospital | |||||||
| Joska
[110], 2011 |
South Africa Hospital |
Cross-sectional |
170 (men 44) HIV + participants (mean age 29.5 y.)never treated; 43 (men 14) with HIV-dementia; 72 (men 19 with MND |
AAN revised criteria |
Mild neurocognitive disorder: 42.4% HIV dementia: 25.4% |
Education, and male gender independent predictors of HIV-dementia |
|
| 2008-2009 | |||||||
| Robertson
[111], 2011 |
Malawi, |
Cross sectional |
133 (men 39) never treated HIV + patients (median age 31 y.) |
Not provided |
MND: 8% |
|
|
| HAD: 0% | |||||||
| Hospital | |||||||
| South Africa, |
167 (men 60) never treated HIV + patients (median age 34 y.) |
Not provided |
MND: 4% |
|
|
||
| HAD: 0% | |||||||
| Hospital | |||||||
| Zimbabwe, Hospital |
80 (men 31) never treated HIV + patients (median age 36 y.) |
Not provided |
MND: 14% |
NA |
860 HIV + HAART naïve patients with CD4 count < 300 cells/mL and KI ≥70% |
||
| HAD: 3% | |||||||
| Robbins
[112], 2011 |
South Africa, |
Cross-sectional |
65 (men 23) HIV + patients on HAART for ≥6 months (mean age 38.5 y) |
IHDS and Xhosa-validated IHDS |
HIV Associated dementia 80% |
Low CD4 counts, alcohol dependency |
|
| Hospital |
2009-2010 |
||||||
| Kwasa
[113], 2012 |
Kenya, |
Cross sectional |
30 (men 17) HIV + patients (mean age 39 y.) |
Neuropsychological test battery MMSE/IHDS (cut-off ≤10) |
HAD 20% |
NA |
|
| Hospital |
6 (men 5)with HAD |
||||||
| Spies
[114], 2012 |
South-Africa, |
Case–control |
35 HIV + without childhood trauma; mean age: 31.5 y |
Neuropsychological test battery |
NA |
NA |
Significant HIV effects for the Hopkins Verbal Learning Test (HVLT) learning and delay trials and the Halstead Category Test (HCT) |
| Hospital |
48 HIV + with childhood trauma; mean age: 31.7 y |
||||||
| 27 HIV- without childhood trauma; mean: 25y | |||||||
| 20 HIV- with childhood trauma; mean age: 27 · 7 y | |||||||
| All participants were women. | |||||||
| Hestad
[115], 2012 |
Zambia, Hospital |
Case–control |
38 HIV + (men 16); mean age: 28.3 y 42 HIV- (men 18); mean age: 28.9 y |
Neuropsychological tests |
NA |
NA |
HIV + individuals performance lower than that of HIV- on verbal fluency, executive function, speed of information processing, verbal episodic memory and motor function |
| Berhe
[116], 2012 |
Ethiopia, |
Cross-sectional |
347 HIV + (men 176) participants; mean age/range: 34.6 y admitted with neurological disorders |
“cognitive and motor abnormalities, CT/MRI showing brain atrophy and other opportunistic infections ruled out” |
HIV encephalopathy: 0.3% |
NA |
|
| Hospital |
Retrospective |
||||||
| 10 had dementia | |||||||
| 2002-2009 | |||||||
| Joska
[117], 2012 |
South Africa, |
Prospective |
166 HIV + participants assessed at baseline, 108 reassessed at one year (82 received HAART) |
Neuropsychological tests |
NA |
Lower level of education |
Improvement on neuropsychological tests for all participants at one year. |
| Average Global deficit score | |||||||
| Hospital | |||||||
| Breuer
[118], 2012 |
South Africa, |
Cross-sectional |
269 HIV + (men 97) participants on HAART for ≥6; months; 34% aged >40 y) |
IHDS (cut-off ≤10.5) |
HAND: 12% |
NA |
|
| Hospital | |||||||
| Hoare
[119], 2012 |
South Africa |
Cross-sectional |
43 stage III HIV + (24 with at least one ϵ4 ApoE allele, men: 8, Age: 29 y and 19 without the ϵ4 ApoE allele, men: 2, Age: 28 y) |
Neuropsychological test battery |
NA |
Performance on Hodgkin Verbal Learning Tool- Revised was poorer in the group with the ϵ4 genotype. |
|
| Participants with the ϵ4 genotype had more white matter injury on MRI. | |||||||
| Hospital | |||||||
| Oshinaike
[120], 2012 |
Nigeria |
Case–control |
208 HIV + (men 71), mean age: 36.8 y |
IHDS (cut off ≤10) |
HAND by MMSE: 2.9% |
Lower CD4 count |
|
| Hospital |
2007-2008 |
||||||
| 121 HIV – (men: 35), mean age:38.0 y |
MMSE (cut off ≤26) |
||||||
| AAN revised criteria (any value below 2SD) | |||||||
| HAND by IHDS: 54.3% | |||||||
| HAND by AAN: 42.3% | |||||||
| Royal [121], 2012 | Nigeria, Hospital | Cross-sectional | 60 (men 23) never treated HIV + participants (mean age 34 y); |
IHDS (cut off ≤10) | 28.8% HIV + individuals scored abnormally |
Low CD4 count, WHO clinical stage of disease | |
| 56 (men 34) HIV- (mean age 29 · 4 y.); 32 had dementia | |||||||
| 16.0% HIV- individuals scored abnormally |
3TC: Lamivudine; AIDS: Acquired Immunodeficiency Syndrome; CD4: cluster of differentiation 4; CSID: Community Screening Interview for Dementia; CT: computerized tomography; DSM-III-R: Diagnostic and Statistical Manual 3rd edition revised; DSM-IV: Diagnostic and Statistical Manual 4th edition; dT4: Didanosine; FePsy: The Ion Psyche Program; HAART: Highly Active Anti-Retroviral Treatment; HAD: HIV Associated Dementia; HAND: HIV Associated Neurocognitive Disorders; HDS: HIV Dementia Scale; HIV: Human Immunodeficiency Virus; ICD-III-R: International Classification of Disease; IHDS: International HIV Dementia Scale; MSK: Memorial Sloan Kettering; MMSE: Mini Mental State Examination; MND: Mild Neurocognitive Disorder; NA: Not available; NVP: Nevirapine; WHO: World Health Organization; y, years; ZDV: Zidovudine.