Table 3 Overview of studies on HIV-related dementia and risk factors in sub-Saharan

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