Volume 80, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Human immunodeficiency virus–associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data. Stage IV PLWAs performed worse than the comparison group on all tests. Overall, 24 (50%) of 48 PLWAs had significant cognitive impairment. Among HIV staging categories, 1 stage II (33%), 6 stage III (42%), and 17 stage IV (55%) patients were identified as cognitively impaired. Our pilot study indicates that screening instruments used by non-physician healthcare workers can identify cognitive impairment in PLWAs and may facilitate appropriate initiation of ART in resource-poor settings.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2006. Towards Universal Access by 2010: How WHO is Working with Countries to Scale-up HIV Prevention, Treatment, Care and Support Page. Available at: http://www.who.int/hiv/pub/advocacy/universalaccess/en/. Accessed March 5, 2008.
  2. Tozzi V, Balestra P, Bellagamba R, Corpolongo A, Salvatori MF, Visco-Comandini U, Vlassi C, Giulianelli M, Galgani S, Antinori A, Narciso P, 2007. Persistence of neuropsychological deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors. J Acquir Immune Defic Syndr 45: 174–182. [Google Scholar]
  3. Stringer JS, Zulu I, Levy J, Stringer EM, Mwango A, Chi BH, Mtonga V, Reid S, Cantrell RA, Bulterys M, Saag MS, Marlink RG, Mwinga A, Ellerbrock TV, Sinkala M, 2006. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA 296: 782–793. [Google Scholar]
  4. Muula AS, Chipeta J, Siziya S, Rudatsikira E, Mataya RHK, Ataika E, 2007. Human resources requirements for highly active antiretroviral therapy scale-up in Malawi. BMC Health Serv Res 7: 208. [Google Scholar]
  5. Kober K, Van Damme W, 2004. Scaling up access to antiretroviral treatment in southern Africa: who will do the job? Lancet 364: 103–107. [Google Scholar]
  6. Clifford DB, Mitike MT, Mekonnen Y, Zhang J, Zenebe G, Melaku Z, Zewde A, Gessesse N, Wolday D, Messele T, Teshome M, Evans S, 2007. Neurological evaluation of untreated human immunodeficiency virus infected adults in Ethiopia. J Neurovirol 13: 67–72. [Google Scholar]
  7. Modi G, Hari K, Modi M, Mochan A, 2007. The frequency and profile of neurology in black South African HIV infected (clade C) patients: a hospital-based prospective audit. J Neurol Sci 254: 60–64. [Google Scholar]
  8. Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, Robertson K, McArthur JC, Ronald A, Katabira E, 2005. The international HIV dementia scale: a new rapid screening test for HIV dementia. AIDS 19: 1367–1374. [Google Scholar]
  9. Power C, Selnes OA, Grim JA, McArthur JC, 1995. HIV dementia scale: a rapid screening test. J Acquir Immune Defic Syndr Hum Retrovirol 8: 273–278. [Google Scholar]
  10. Wojna V, Skolasky RL, Hechavarria R, May R, Selnes O, McArthur JC, Melendez LM, Maldonado E, Zorrilla CD, Garcia H, Kraiselburd E, Nath A, 2006. Prevalence of human immunodeficiency virus-associated cognitive impairment in a group of Hispanic women at risk for neurological impairment. J Neurovirol 12: 356–364. [Google Scholar]
  11. WHO/UNAIDS, 2004. Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections: Zambia Page. Available at: http://www.who.int/globalatlas/predefinedReports/EFS2004/index.asp. Accessed March 5, 2008.
  12. World Health Organization, 1990. Interim proposal for a WHO staging system for HIV infection and disease. Wkly Epidemiol Rec 65: 221–224. [Google Scholar]
  13. Miller WC, Thielman NM, Swai N, Cegielski JP, Shao J, Manyenga D, Mlalasi J, Lallinger GJ, 1995. Diagnosis and screening of HIV/AIDS using clinical criteria in Tanzanian adults. J Acquir Immune Defic Syndr Hum Retrovirol 9: 408–414. [Google Scholar]
  14. Folstein MF, Folstein SE, McHugh PR, 1975. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198. [Google Scholar]
  15. Maj M, D’Elia L, Satz P, Janssen R, Zaudig M, Uchiyama C, Starace F, Galderisi S, Chervinsky A, 1993. Evaluation of two new neuropsychologicalal tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study. Arch Clin Neuropsychol 8: 123–135. [Google Scholar]
  16. Gladstone M, Lancaster G, Jones A, Maleta K, Mtitimila E, Ashorn P, Smyth R, 2007. Can Western developmental screening tools be modified for use in a rural Malawian setting? Arch Dis Child 93: 23–29. [Google Scholar]
  17. Maj M, Satz P, Janssen R, Zaudig M, Starace F, D’Elia L, Sughondhabirom B, Mussa M, Naber D, Ndetei D, 1994. WHO Neuropsychiatric AIDS study, cross-sectional phase II. Neuropsychologicalal and neurological findings. Arch Gen Psychiatry 51: 51–61. [Google Scholar]
  18. Sebit MB, 1995. Neuropsychiatric HIV-1 infection study: in Kenya and Zaire cross-sectional phase I and II. Cent Afr J Med 41: 315–322. [Google Scholar]
  19. Belec PL, Testa J, Vohito MD, Gresenguet G, Martin MI, Tabo A, Di Costanzo B, Georges AJ, 1989. Neurologic and psychiatric manifestations of AIDS in Central African Republic [in French]. Bull Soc Pathol Exot Filiales 82: 297–307. [Google Scholar]
  20. Howlett WP, Nkya WM, Mmuni KA, Missalek WR, 1989. Neurological disorders in AIDS and HIV disease in the northern zone of Tanzania. AIDS 3: 289–296. [Google Scholar]
  21. Wong MH, Robertson K, Nakasujja N, Skolasky R, Musisi S, Katabira E, McArthur JC, Ronald A, Sacktor N, 2007. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology 68: 350–355. [Google Scholar]
  22. Dore GJ, Correll PK, Li Y, Kaldor JM, Cooper DA, Brew BJ, 1999. Changes to AIDS dementia complex in the era of highly active antiretroviral therapy. AIDS 13: 1249–1253. [Google Scholar]
  23. Janssen RS, Nwanyanwu OC, Selik RM, Stehr-Green JK, 1992. Epidemiology of human immunodeficiency virus encephalopathy in the United States. Neurology 42: 1472–1476. [Google Scholar]
  24. McGrath NM, Cooke GS, 2007. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology 69: 411–412, author reply 412–413. [Google Scholar]

Data & Media loading...


  • Received : 04 Apr 2008
  • Accepted : 19 Feb 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error