+1 (629)348-3199Editorial - Neurophysiology Research (2021) Volume 3, Issue 2
International Settings in Neuropsychological Assessment of HIV-Infected Populations
Note: This work is partially presented at World Conference On Neurology and Neurosurgery, Paris, France | March 27, 2019.
Editorial
Resource-limited regions of the world represent the areas
most affected by the global HIV epidemic. Currently, there are
insufficient data on the neurocognitive effects of HIV in these
areas and neuropsychological studies that have been carried
out thus far are marked by inconsistent methods, test batteries,
and rating systems for levels of cognitive impairment. These
differences in methods, along with genetic variability of both virus
and host, differences in co-infections and other co-morbidities,
differences in language and culture, and infrastructural
deficiencies in many international settings create challenges to
the assessment of neurocognitive functioning and interpretation
of neuropsychological data. Identifying neurocognitive
impairment directly attributable to HIV, exploring relationships
between HIV-associated neurocognitive impairment, disease
variables, and everyday functioning, evaluating differences in
HIV-1 subtype associated neuropathology, and determining
implications for treatment remain complicated and challenging
goals. Endeavors to establish a more standardized approach
to neurocognitive assessments across international studies
in addition to accumulating appropriate normative data that
will allow more accurate rating of neuropsychological test
performance will be crucial to future efforts attempting to achieve
these goals. The establishment of highly active antiretroviral
therapy as the mainstay of HIV treatment in developed nations
has led to impressive reductions in the prevalence of severe
HIV-associated neurocognitive disorders (HAND) and central
nervous system (CNS) opportunistic infections. Accounts of
HIV-associated dementia in these settings are now generally
limited to patients who are either treatment naïve or are failing
therapy due to viral drug resistance or problems with adherence.
Milder forms of neurocognitive dysfunction, however, are still
prevalent and continue to be under recognized in patients on
antiretroviral therapy. Most of the studies to date investigating
the action of highly active antiretroviral therapy at improving
neurological and cognitive dysfunction have been carried out in
the resource intense settings of the US, Europe, and Australia.
Resource-limited communities in Sub-Saharan Africa, Asia,
and the rest of the developing world, however, represent the
areas most devastated by the HIV epidemic. These areas offer
considerable potential for research and stand to gain the most
from effective therapy. Neuropsychological assessments are
arguably the most important tools for diagnosing and categorizing
HIV effects on the CNS. Especially in resource-limited
settings, where sophisticated neuroimaging technology often
is unavailable, characterization of neurocognitive functioning
through neuropsychological assessments is crucial to successful
diagnosis and treatment. When assessments are reliable and
valid, and appropriate normative standards exist, they are quite
sensitive to even milder forms of CNS compromise and also may
provide valuable estimates of functional impairment. This article
presents a review of the current status, as well as the potential,
and some challenges to conducting neuropsychological
assessments in resource-limited settings, with a focus on HIVinfected
populations. HIV is a truly global disease, affecting
roughly 33 million people all over the world. The number of
people infected with HIV in the United States, Western Europe
and Oceania however represent only 4% of worldwide infections.
Most of the people infected or affected by HIV live in developing
countries where cultural values, social influences, educational
opportunities and access to other resources are clearly distinct
from those in the West. Africa and the Middle East account for
over 66% of worldwide infections, Asia for over 20%, Eastern
Europe and Central Asia for approximately 4%, and Latin
America and the Caribbean for around 6%.
Author(s): Minsi Monja,