Detecting HIV associated neurocognitive disorders (HAND) using neurocognitive assessment test in Uganda

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Epidemiology. August, 2017.Background: HIV associated neurocognitive disorders (HAND), are a well-established consequence of HIV infection yet there is a lack of normative data required for diagnosis in Sub-Saharan Africa. Screening tools such as the International HIV dementia scale (IHDS) that are routinely used in the Sub-Saharan African region have questionable validity. This study investigates the use of the neuropsychological test battery in the detection of HAND in the absence of normative data. Further, the construct validity of the IHDS in the detection of HAND in the Ugandan context is examined. Methods Secondary data from a longitudinal Mental Health study carried out in Uganda were analysed. Information from a total of 1121 patients who underwent neuropsychological assessment in the main study qualified for the present study. A descriptive analysis of the neuropsychological performance of the study participants was conducted. To assess the relationship between demographic factors and the neurocognitive test scores of the neuropsychological test battery, multiple linear regression models were fitted. To determine how well the neuropsychological test battery predicted the IHDS score, a receiver-operating curve (ROC) analysis was conducted. The construct validity of the IHDS in detecting HAND in the Ugandan population was then assessed using ROC analysis and published normative data. Results The total study population was 1,121 participants, with the majority being female (66.3%) while almost 62% had only primary school education. The mean age of the study participants was 35.0±9.3 years. Using the IHDS, 73.3% of the HIV infected patients were identified to be at risk of developing HIV associated dementia (HAD). Using the Frascati criteria and published normative data, only 9.1% of the HIV infected patients had HAND. Ageing, being female, having a lower socio-economic score and having lower levels of education were identified as predictors for poor neurocognitive performance. Poor performance in the neurocognitive measures to assess gross and fine motor function was directly proportional to poor performance in the IHDS (score ≥10 points). Better performance in the neurocognitive measures to assess verbal leaning/working memory and attention/working memory was directly proportional to poor performance in the IHDS (score ≥10 points). The neurocognitive tests discriminated modestly between patients at risk of developing HAD and those that were not at risk of developing HAD (sensitivity=64.62%; specificity=66.67%). At the recommended cut-off score of 10 points, the IHDS had poor ability to identify patients with HAND (sensitivity=34.54%) and a high ability to identify patients without HAND (specificity=90.74%). At a cut-off point of 7 points, the IHDS discriminated modestly between patients with HAND and those without (sensitivity=65.66%; specificity=58.52%). Conclusion The neuropsychological test battery used in the present study discriminated modestly among HIV patients at risk of developing HIV associated dementia and those that were not at risk of developing dementia. In the Ugandan population, the construct validity of the IHDS in the diagnosis of HAND was poor. Further work is required to produce an algorithm to detect HAND in the absence of normative data. This includes an inclusion of important clinical biomarkers, exploration of further demographic confounders as well strengthening of the HAND diagnostic criteria using the neuropsychological test battery.LG201

Annual Tuberculosis Preventive Therapy for Persons With HIV Infection : A Randomized Trial.

Between November 2016 and November 2017, 4027 participants were enrolled; 4014 were included in the analyses (median age, 41 years; 69.5% women; all using antiretroviral therapy). Treatment completion in the first year for the combined rifapentine-isoniazid groups (n = 3610) was 90.4% versus 50.5% for the isoniazid group (n = 404) (risk ratio, 1.78 [95% CI, 1.61 to 1.95]). Tuberculosis incidence among participants receiving the rifapentine-isoniazid regimen twice (n = 1808) or once (n = 1802) was similar (hazard ratio, 0.96 [CI, 0.61 to 1.50])