Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study

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dc.contributor.authorJoska, Johnen_ZA
dc.contributor.authorWestgarth-Taylor, Jenniferen_ZA
dc.contributor.authorHoare, Jacquelineen_ZA
dc.contributor.authorThomas, Kevinen_ZA
dc.contributor.authorPaul, Roberten_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorStein, Danen_ZA
dc.date.accessioned2015-10-28T07:08:44Z
dc.date.available2015-10-28T07:08:44Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND:Infection with HIV may result in significant neuropsychological impairment, especially in late stage disease. To date, there have been no cohort studies of the impact of highly active anti-retroviral treatment (HAART) in South Africa where clade C HIV is predominant. METHODS: Participants in the current study were recruited from a larger study of HIV-associated neurocognitive disorders (HAND) and included a group of individuals commencing HAART (n = 82). Baseline and one-year neuropsychological function was assessed using a detailed battery, and summary global deficit scores (GDS) obtained. Associations with change in GDS were calculated. RESULTS: Participants had a median CD4 cell count of 166 at baseline and 350 at follow-up. There were significant difference across groups of GDS severity at baseline with respect to level of education and GDS change at one year (p = 0.00 and 0.00 respectively). Participants with severe impairment at baseline improved significantly more than those with lesser degrees of impairment. Significant improvements were observed in the domains of attention, verbal fluency, motor function, and executive functions. There were unadjusted associations between GDS change and male gender, lower levels of education, baseline CD4 count and baseline GDS severity. In an adjusted model, only baseline GDS severity (p = 0.00) remained significant, with a lower level of education nearing significance (p = 0.05). The overall model was highly significant (p = 00; r-squared = 0.58).DISCUSSION:In individuals in late stage HIV commencing HAART in South Africa, those with severe baseline neuropsychological impairment improved significantly more than those less impaired. While improvement across a number of neuropsychological domains was observed, high rates of impairment persisted. CONCLUSIONS: The effects of HAART and participant variables, such as test experience, require clarification. Studies with larger comparison groups, and where HIV disease characteristics are needed to establish whether the trends we identified are clinically meaningful.en_ZA
dc.identifier.apacitationJoska, J., Westgarth-Taylor, J., Hoare, J., Thomas, K., Paul, R., Myer, L., & Stein, D. (2012). Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14480en_ZA
dc.identifier.chicagocitationJoska, John, Jennifer Westgarth-Taylor, Jacqueline Hoare, Kevin Thomas, Robert Paul, Landon Myer, and Dan Stein "Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study." <i>BMC Infectious Diseases</i> (2012) http://hdl.handle.net/11427/14480en_ZA
dc.identifier.citationJoska, J. A., Westgarth-Taylor, J., Hoare, J., Thomas, K. G., Paul, R., Myer, L., & Stein, D. J. (2012). Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study. BMC infectious diseases, 12(1), 39.en_ZA
dc.identifier.ris TY - Journal Article AU - Joska, John AU - Westgarth-Taylor, Jennifer AU - Hoare, Jacqueline AU - Thomas, Kevin AU - Paul, Robert AU - Myer, Landon AU - Stein, Dan AB - BACKGROUND:Infection with HIV may result in significant neuropsychological impairment, especially in late stage disease. To date, there have been no cohort studies of the impact of highly active anti-retroviral treatment (HAART) in South Africa where clade C HIV is predominant. METHODS: Participants in the current study were recruited from a larger study of HIV-associated neurocognitive disorders (HAND) and included a group of individuals commencing HAART (n = 82). Baseline and one-year neuropsychological function was assessed using a detailed battery, and summary global deficit scores (GDS) obtained. Associations with change in GDS were calculated. RESULTS: Participants had a median CD4 cell count of 166 at baseline and 350 at follow-up. There were significant difference across groups of GDS severity at baseline with respect to level of education and GDS change at one year (p = 0.00 and 0.00 respectively). Participants with severe impairment at baseline improved significantly more than those with lesser degrees of impairment. Significant improvements were observed in the domains of attention, verbal fluency, motor function, and executive functions. There were unadjusted associations between GDS change and male gender, lower levels of education, baseline CD4 count and baseline GDS severity. In an adjusted model, only baseline GDS severity (p = 0.00) remained significant, with a lower level of education nearing significance (p = 0.05). The overall model was highly significant (p = 00; r-squared = 0.58).DISCUSSION:In individuals in late stage HIV commencing HAART in South Africa, those with severe baseline neuropsychological impairment improved significantly more than those less impaired. While improvement across a number of neuropsychological domains was observed, high rates of impairment persisted. CONCLUSIONS: The effects of HAART and participant variables, such as test experience, require clarification. Studies with larger comparison groups, and where HIV disease characteristics are needed to establish whether the trends we identified are clinically meaningful. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2334-12-39 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study TI - Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study UR - http://hdl.handle.net/11427/14480 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14480
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-12-39
dc.identifier.vancouvercitationJoska J, Westgarth-Taylor J, Hoare J, Thomas K, Paul R, Myer L, et al. Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study. BMC Infectious Diseases. 2012; http://hdl.handle.net/11427/14480.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2012 Joska et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherHIV neuropsychologyen_ZA
dc.subject.otherClade Cen_ZA
dc.subject.otherCombination anti-retroviral therapyen_ZA
dc.subject.otherNeuropsychological outcomesen_ZA
dc.titleNeuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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