Durban - Screening people living with HIV for dementia and related mental illnesses, and starting them on treatment quickly, can stop the progression of the disorder, which would otherwise limit their lives.
This was the recommendation of Dr Jade Caris Mogambery in her paper presented at the International Aids Conference on Wednesday.
Mogambery, who works at Grey’s Hospital in Pietermaritzburg, studied HIV Associated Neurocognitive Disorders (HAND), which HIV positive patients may get because the virus invades the central nervous system.
Dr Kevin Rebe, an infectious diseases physician working at non-governmental organisation Anova Health Institute, said HAND was when HIV affected the neurological system.
“There is a huge different array of interactions; one of the things is direct effects of HIV, in other words how the virus itself affects the brain. The other conditions are what happens if HIV damages the immune system and it is no longer able to protect against opportunistic infections, which then affect the neurological system.”
Rebe said people with weak immunity – because of prolonged HIV – develop various types of bacteria, like viral meningitis, and even parasitic infections. Also, HIV itself is toxic to the cells of the brain, and that led to structural damage, which could change the composition of chemicals circulating in the brain.
This, could also lead to disorders, said Rebe.
According to the US National Institute of Mental Health, HAND could impair the activity of nerves involved in attention, memory, language, problem-solving and decision-making.
“A lot of them are quite subtle; unless you start doing very specific testing, you don’t even know that they are there. But once you do testing, you might find things – like what we call visio-spacial difficulties – for example, difficulty judging space and speed could become a problem. Difficulty with very fine motor control and very fine, complicated movement can be very difficult,” said Rebe.
Mogambery said the prevalence of the disorder in KwaZulu-Natal was not known, but their study had looked at almost 150 HIV positive patients who had not been started on treatment.
“We did a test called the International Dementia Scale to determine if they had the disorder. Of the 146 people in the study, 53% were found to have HAND, but it did not affect their capacity. This means that they lived normally and were able to do everything they needed to do. Of these people, 73% improved when they were started on ARV treatment,” she said.
Generally, research showed that people with a low CD4 count who had HIV for a long time were likely to have Hand.
Mogambery’s study showed that patients who were older than 50 years were at greater risk of developing the disorder.
She concluded that people who had the disorder should start ARVs sooner, which wold no longer be an issue from September, when test and treat, regardless of CD4 count, would be implemented.
“Prior to this new era that we are approaching, we should have been screening for HAND, and if the patient did have- even asymptomatic neuro-cognitive impairment, they would benefit from ART early because it wouldn’t progress to the symptomatic form,” Mogambery said.
It could have saved people living with HIV from symptoms like depression, inability to concentrate, and impairment of motors skills and, if severe, being bed-ridden.