Adult neuropsychological testing in Zambia’s HIV positive population on combined antiretroviral therapy

Abstract

The effect of human immunodeficiency virus (HIV) on the central nervous system results in a number of cognitive problems. Although the introduction of combined antiretroviral therapy (CART) has resulted in the reduction in severe cognitive disruptions, the milder forms of cognitive problems have continued to rise as HIV+ people live longer. This phenomenon is well researched in the Western world where HIV clade B dominates. However, HIV clade C hit regions (especially sub Saharan Africa), which carry the majority of the world’s HIV cases, have only in the last few years began exploring the effect of HIV on cognitive functions / neuropsychological functions. Furthermore, the neuropsychological tests that are used to measure cognitive functioning largely originate from the Western world, and as such, if they are to be imported, these tests should be culturally appropriate and normed for the populations to which they are being exported. This would be helpful in determining the acceptable level of cognitive performance in those populations and for diagnostic purposes. The current thesis was based on the premise of filling the gap owing to the lack of validated neuropsychological tests meant to measure cognitive functions in HIV+ adults in Zambia. Efforts were made to determine how well imported neuropsychological tests would be able to isolate HIV related cognitive problems in the Zambian adult population. The results obtained in the current thesis were comparable to those observed internationally. The results also showed that having AIDS and high levels of HIV in the blood were associated with poor cognitive functioning. Furthermore, it was observed that the female HIV+ participants had more HIV related cognitive difficulties than the male HIV+ participants. Another interesting finding was that the younger and less educated HIV+ participants appeared to experience more cognitive difficulties compared to the younger more educated HIV+ participants.