12th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 22-25, 2005

Conf Retrovir Opportunistic Infect 2005 Feb 22-25;12:abstract no. 9

Ned Sacktor¹, N Nakasujja², M Wong³, R Skolasky¹, K Robertson⁴, S Musisi², E Katabira², and A Ronald^5
1Johns Hopkins Univ, Baltimore, MD, USA; ²Makerere Univ, Kampala, Uganda; ³Univ of Calgary, AB, Canada; ⁴Univ of North Carolina at Chapel Hill, USA; and ⁵Univ of Manitoba, Winnipeg, Canada

BACKGROUND: The vast majority of HIV cases globally, an estimated 26.6 million people, are in Sub-Saharan Africa. HIV dementia is seen in about 10 to 15% of HIV+ individuals with advanced infection in the United States. The frequency of HIV dementia in a recent study of ambulatory HIV+ patients in Kampala, Uganda, was 30%. HAART can improve neurocognitive performance in individuals with HIV-associated cognitive impairment in the United States, and the incidence of HIV dementia has decreased by 50% since the introduction of HAART. The effect of HAART on HIV dementia in Sub-Saharan Africa, where predominant clade subtypes differ from those in the United States, is largely unknown. The objective of this study was to evaluate neuropsychological testing performance in HIV+ individuals after 3 months and 6 months of HAART in Uganda.

METHODS: For 6 months we followed 20 HIV+ individuals who had received neurological, neuropsychological, and functional assessments, and had initiated HAART (90% with zidovudine, lamivudine, tenofovir). Neuropsychological test Z scores were obtained using age- and education-adjusted normative data obtained among HIV– individuals in Uganda, The change in mean Z score for each neuropsychological test was evaluated at 3 and 6 months using a paired t-test.

RESULTS: After 3 months of HAART in 20 HIV+ individuals, there was improvement in the WHO–UCLA Auditory Verbal Learning test (AVLT) total score (mean baseline Z score = –1.50, 3-month Z score = –0.40, p = 0.002) and delayed recall score (mean baseline Z score = –0.98, 3-month Z score = –0.06, p < 0.001), Symbol Digit Modalities test (mean baseline Z score = –0.89, 3-month Z score = –0.34, p = 0.009), and Color Trails Part 1 test (mean baseline Z score = –0.94, 3-month Z score = –0.22, p = 0.04). After 6 months on HAART in 12 HIV+ individuals, there were significant improvements in the AVLT total score (6-month Z score = –0.32, p = 0.007), and delayed recall score (6-month Z score = –0.20, p = 0.02).

CONCLUSIONS: HAART can be associated with improvement in neurocognitive performance in HIV+ individuals in Uganda. Additional 6-month follow-up data will be obtained to improve our ability to generalize our results to the larger Uganda HIV+ population. A diagnosis of HIV dementia in Sub-Saharan Africa may be an indication for the initiation of HAART if available.

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Copyright © 2005 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.