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Abstract no. WEPDB0104
JC Mogambery1, H Dawood2, D Wilson3, A Moodley4
1 Grey’s Hospital, Infectious Disease Unit, UKZN
2 Grey’s Hospital, Infectious Disease Unit, UKZN, CAPRISA
3 Edendale Hospital, Department of Internal Medicine, UKZN
4 Grey’s Hospital, Department of Neurology, UKZN
HIV ASSOCIATED
NEUROCOGNITIVE DISORDER IN
A PERI-URBAN HIV CLINIC IN
KWAZULU-NATAL, SOUTH
AFRICA
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Background
Nightingale et al, Lancet Neuro, 2014
• Prevalence: 15-60% but is unknown in KwaZulu-Natal
• Neurocognitive tests: tedious, specialized personnel
Aims and methods
• Prevalence of HAND using International HIV Dementia Scale
• Functional capacity of those with HAND using Eastern Cooperative
Oncology Group
• Factors associated with HAND
• Investigate the utility of two other neurocognitive tests
• Determine association between HAND and non-adherence
Consecutive HIV infected, ART naïve patients were enrolled
Exclusion: Age > 65, CNS infection/disease, mental health care users
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Results
• 146 patients
–
–
–
–
Female (54.1%)
African (99.3%)
Age: median 35 years old (range 18-58 years old)
CD4 count: median 178 cells/uL (IQR 86 – 283.5 cells/uL)
• Prevalence: 53%
• No functional impairment in 99.9% using ECOG#
• Risk factors: Age > 50 years old (p=0.003), CD4 count
not associated with HAND
• GUGT and CESD-r did not correlate with IHDS
• Detectable viral load after 6 months ART ≈ nonadherence. HAND 35% and no HAND 20% (p = 0.06)
*
**
*(GUGT)Get-up-and-go Test
**(CESD-R)Centers for Epidemiological Study – Depression scale -revised
# (ECOG) Eastern Cooperative Oncology Group
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Conclusion
• High prevalence of HAND in this setting
• Asymptomatic neurocognitive impairment:
predominant presentation of HAND
– Leads to symptomatic forms of HAND
• Risk factors: Age > 50 years old
– Routine screening of older patients
recommended
• HAND and non-adherence association
requires further exploration
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Acknowledgements
• Co-investigators
• Funder: Mentorship grant from Canadian Prevention and Treatment
Network
• Medical and nursing staff at Edendale CDC Clinic for their assistance
• Ms Zama Mhlongo, research assistant
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