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NEUROLOGY 2008;71:50-56
© 2008 American Academy of Neurology

Neurologic disorders are prevalent in HIV-positive outpatients in the Asia-Pacific region

E. Wright, MBBS, FRACP, B. Brew, MBBS, MD, FRACP, A. Arayawichanont, MD, K. Robertson, PhD, K. Samintharapanya, MD, S. Kongsaengdao, MD, M. Lim, BBioMedSci, S. Vonthanak, MD, L. Lal, BPharm, BAppSci, C. Sarim, MD, S. Huffam, MBBS, MPH, P. Li, MD, D. Imran, MD, J. Lewis, BSc, MBiostat, W. H. Lun, MD, A. Kamarulzaman, MBBS, FRACP, G. Tau, MBBS, S. T. Ali, MD, K. Kishore, MBBS, M. P. Bain, BSc(Psych)A, MClinPsych, R. Dwyer, MBBS, BMedSci, G. McCormack, MBBS, M. Hellard, MBBS, PhD, FRACP, MPH, C. Cherry, MBBS, J. McArthur, MD and S. Wesselingh, BMBS, PhD, FR ACP

From The Alfred Hospital (E.W., M.H., C.C., S.W.), Melbourne; Burnet Institute (E.W., M.L., L.L., J.L., G.M., M.H., C.C., S.W.), Melbourne, Australia; Monash University (E.W., L.L., R.D., S.W.), Victoria, Australia; St Vincent's Hospital (B.B., M.P.B.), Sydney; University of New South Wales (B.B.), Sydney, Australia; Sappasithiprasong Hospital (A.A.), Ubon Ratchathani, Thailand; University of North Carolina at Chapel Hill (K.R.); Lampang Hospital (K.S.), Thailand; Rajavithi Hospital (S.K.), Bangkok, Thailand; National Centre for HIV/AIDS (S.V., C.S., S.H.), Dermatology and STDs, Phnom Penh, Cambodia; Queen Elizabeth Hospital (P.L.), Kowloon, Hong Kong; Cipto Mangunkusumo Hospital (D.I.), Jakarta, Indonesia; Ditan Hospital (W.H.L.), Beijing, China; University of Malaya Medical Centre (A.K.), Kuala Lumpur, Malaysia; Port Moresby General Hospital (G.T.), Port Moresby, Papua New Guinea; Fiji School of Medicine (S.T.A., K.K.), Suva; and Johns Hopkins Hospital (J.M.), Baltimore, MD.

Address correspondence and reprint requests to Dr. Edwina Wright, Department of Infectious Diseases, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia e.wright{at}alfred.org.au

Background: A total of 8.3 million HIV-positive people live in the Asia-Pacific region. The burden of HIV-associated neurocognitive impairment and symptomatic sensory neuropathy in this region is unknown.

Methods: Between July 2005 and March 2006, we undertook a cross-sectional study at 10 sentinel sites within eight Asia-Pacific countries to determine the prevalence of moderate to severe HIV-related neurocognitive impairment and symptomatic sensory neuropathy. We clinically assessed and administered sensitive neuropsychological and peripheral neuropathy screening tools to 658 patients infected with HIV. Univariate and logistic regression analyses were applied to the data.

Results: The results showed that 76 patients (11.7%) (95% CI 9.3–14.2) were significantly neurocognitively impaired, 235 patients (36.4%) (95% CI 32.7–40.2) were depressed, and 126 patients (19.7%) (95% CI 16.6–22.8) had either definite or probable symptomatic sensory neuropathy; 63% of this last group had exposure to stavudine, didanosine, or zalcitabine. Several potential confounders including depression (OR 1.49, 95% CI 0.88–2.51, p = 0.11) and prior CNS AIDS illness (OR 1.28, 95% CI 0.50–2.89, p = 0.54) were not significantly associated with neurocognitive impairment.

Conclusions: A total of 12% of patients had moderate to severe HIV-related neurocognitive impairment, 20% of patients had symptomatic sensory neuropathy, and 36% of patients had evidence of depression. This study provides a broad regional estimate of the burden of HIV-related neurologic disease and depression in the Asia-Pacific region.

Abbreviations: AP = Asia-Pacific; APNAC = Asia Pacific NeuroAIDS Consortium; ARV = antiretroviral; CES-D = Center for Epidemiologic Studies-Depression Scale; HAART = highly active antiretroviral therapy; HAD = HIV-associated dementia; NCI = neurocognitive impairment; SN = sensory peripheral neuropathy.

Supplemental data at www.neurology.org

Supported by the National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke (NIH).

Disclosure: The authors report no disclosures.

Received November 11, 2007. Accepted in final form March 7, 2008.






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