Mental Health Repository

Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis.

Journal: Neurology

Volume: 95

Issue: 19

Year of Publication: 2020

Affiliated Institutions: From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia. From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia. baoyp@bjmu.edu.cn linlu@bjmu.edu.cn.

Abstract summary

To characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.We searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.Of 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7-45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3-26.8), 13.3% (10.6-16.3), and 5.0% (3.5-6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5-49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7-41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300-17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000-13,568,000).Our findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

Authors & Co-authors: Wang Yunhe Y Liu Moxuan M Lu Qingdong Q Farrell Michael M Lappin Julia M JM Shi Jie J Lu Lin L Bao Yanping Y

Study Outcome

Statistics

Citations :
Authors : 8

Identifiers

Doi : 10.1212/WNL.0000000000010752
SSN : 1526-632X

Study Population

Male,Female

Mesh Terms

AIDS Dementia Complex

Other Terms

Study Design

Cohort Study,Cross Sectional Study

Study Approach

Country of Study

Publication Country

United States