Skip to main content
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

Share

November 10, 2020; 95 (19) Article

Global prevalence and burden of HIV-associated neurocognitive disorder

A meta-analysis

View ORCID ProfileYunhe Wang, Moxuan Liu, Qingdong Lu, Michael Farrell, Julia M. Lappin, Jie Shi, Lin Lu, Yanping Bao
First published September 4, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010752
Yunhe Wang
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Yunhe Wang
Moxuan Liu
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Qingdong Lu
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Farrell
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Julia M. Lappin
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jie Shi
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lin Lu
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yanping Bao
From the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence (Y.W., M.L., Q.L., J.S., Y.B.), School of Public Health (Y.W., M.L., Q.L., Y.B.), Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital (L.L.), and Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research (L.L.), Peking University, Beijing, China; and National Drug and Alcohol Research Centre (M.F., J.M.L.), University of New South Wales, Sydney, Australia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Short Form
Citation
Global prevalence and burden of HIV-associated neurocognitive disorder
A meta-analysis
Yunhe Wang, Moxuan Liu, Qingdong Lu, Michael Farrell, Julia M. Lappin, Jie Shi, Lin Lu, Yanping Bao
Neurology Nov 2020, 95 (19) e2610-e2621; DOI: 10.1212/WNL.0000000000010752

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
429

Share

  • Article
  • Figures & Data
  • Info & Disclosures
  • CME Course
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Objective To characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.

Methods We searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.

Results Of 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).

Conclusions Our findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

Glossary

AAN=
American Academy of Neurology;
ANI=
asymptomatic neurocognitive impairment;
ART=
antiretroviral therapy;
CI=
confidence interval;
GDS=
Global Deficit Score;
HAD=
HIV-associated dementia;
HAND=
HIV-associated neurocognitive disorder;
HCV=
hepatitis C virus;
MNC=
multivariable normative comparison;
MND=
mild neurocognitive disorder;
MSE=
mental status examination;
START=
Strategic Timing of Antiretroviral Treatment

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received March 18, 2020.
  • Accepted in final form June 4, 2020.
  • © 2020 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Letters: Rapid online correspondence

  • Reader response: Global prevalence and burden of HIV-associated neurocognitive disorder: a meta-analysis
    • Sam Nightingale, Neurologist, HIV Mental Health Research Group, University of Cape Town
    • John A. Joska, Professor of Psychiatry, HIV Mental Health Research Group, University of Cape Town
    • Alan Winston, Professor of HIV and Genitourinary Medicine, Department of Infectious Disease, Imperial College London
    • Magnus Gisslén, Professor of Infectious Diseases, Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg (Sweden)
    • Tristan Barber, Consultant in HIV and Sexual Health, Ian Charleson Day Centre, Royal Free Hospital, London
    Submitted October 26, 2020
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Study funding
    • Disclosure
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
  • CME Course

More Online

CME Course

Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study

Dr. Robert Shapiro and Dr. Amynah Pradhan

► Watch

Related Articles

  • What's happening in Neurology®

Topics Discussed

  • All Cognitive Disorders/Dementia
  • Prevalence studies
  • Public health

Alert Me

  • Alert me when eletters are published
Neurology: 100 (5)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise