People with HIV, particularly patients in sub-Saharan Africa and Latin America, have a high burden of HIV-associated neurocognitive disorder (HAND). This indicates the need for earlier neurologic care and initiation of antiretroviral therapy in this population, according to study results published in Neurology.
HIV, being a neurotropic virus, can invade the central nervous system during early infection, which is often associated with neurological complications like HAND. Study researchers sought to evaluate the burden and prevalence of HAND, as well as related factors in the global community living with the HIV.
This study was a meta-analysis of data from 123 cross-sectional and cohort studies that reported the prevalence of HAND in 35513 adults with HIV from 32 different countries. The pooled prevalence of HAND was estimated, and the overall worldwide burden of the disorder was evaluated.
Across studies, the diagnostic criteria for HAND consisted of the 2007 Frascati criteria in 64 studies, Global Deficit Score in 25 studies, and mental status examinations in 34 studies. Overall, the estimated prevalence of HAND in adults living with HIV was 42.6% (95% CI, 39.7-45.5). The prevalence of asymptomatic neurocognitive impairment (ANI) was 23.5% (95% CI, 20.3-26.8). Additionally, the prevalence of mild neurocognitive disorder (MND) was 13.3% (95% CI, 10.6-16.3) and of HIV-associated dementia (HAD) was 5.0% (95% CI, 3.5-6.8).
The prevalence of HAND was lower in individuals with a high level of nadir CD4 count (mean/median CD4 nadir <200, 45.2%; 95% CI, 40.5-49.9) compared with individuals with a low level of nadir CD4 count (mean/median CD4 nadir ≥200, 37.1%; 95% CI, 32.7-41.7).
The estimated worldwide number of patients with HIV and HAND was approximately 16,145,400 (95% CI, 15,046,300-17,244,500). The majority of cases were in sub-Saharan Africa, which was estimated to be in 72% of this population (n=11,571,200; 95% CI, 9,600,000-13,568,000).
Limitations of this meta-analysis were the inclusion of studies with varying definitions and diagnostic criteria for HAND and the use of screening tools that were limited when applied to certain target populations. Additionally, the use of Frascati criteria and the inclusion of patients with comorbidities that potentially contribute to cognitive impairment may have led to an overestimation of HAND prevalence in adults with HIV.
Based on the findings, the study researchers concluded that “HAND should be prioritised among policy makers and HIV health-care providers for improved detection and efficient management of HAND integrated into routine clinical care in people with HIV.”
Wang Y, Liu M, Lu Q, et al. Global prevalence and burden of HIV-associated neurocognitive disorder: a meta-analysis. Published online September 4, 2020. Neurology. doi:10.1212/WNL.0000000000010752