Showing papers by "Marieke C. J. Dekker published in 2022"
TL;DR: In this first longitudinal study characterizing clinical course of HAND in older c ART-treated PLWH in sub-Saharan Africa, HAND was highly prevalent with variable progression and reversibility and may be more related to cognitive reserve than HIV disease in cART- treated PLWH.
Abstract: Supplemental Digital Content is Available in the Text. Background: HIV-associated neurocognitive disorders (HAND) are a highly prevalent chronic complication in older people living with HIV (PLWH) in high-income countries. Although sub-Saharan Africa has a newly emergent population of older combination antiretroviral therapy (cART)-treated PLWH, HAND have not been studied longitudinally. We assessed longitudinal prevalence of HAND and have identified possible modifiable factors in a population of PLWH aged 50 years or older, over 3 years of follow-up. Methods: Detailed neuropsychological and clinical assessment was completed annually in the period 2016–2019 in a systematic sample of cART-treated PLWH in Kilimanjaro, Tanzania. A consensus panel defined HAND using American Academy of Neurology criteria for asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. HIV disease severity and other factors associated with HAND progression, improvement, and stability were evaluated in individuals fully assessed at baseline and in 2019. Results: At baseline, 47% of the cohort (n = 253, 72.3% female individuals) met HAND criteria despite good HIV disease control [Y1 59.5% (n = 185), Y2 61.7% (n = 162), and Y3 57.9% (n = 121)]. Of participants fully assessed at baseline and year 3 (n = 121), HAND remained stable in 54% (n = 57), improved in 15% (n = 16), and declined in 31% (n = 33). Older age and lower education level significantly predicted HAND progression, whereas HIV-specific factors did not. Male sex and shorter cART duration were associated with improvement. Conclusions: In this first longitudinal study characterizing clinical course of HAND in older cART-treated PLWH in sub-Saharan Africa, HAND was highly prevalent with variable progression and reversibility. Progression may be more related to cognitive reserve than HIV disease in cART-treated PLWH.
2 citations
TL;DR: The main pattern of neurological disorders in Northern Tanzania is presented and the odds of HIV infection was highest in CNS infections and in a wide range of non-communicable neurological disorders.
Abstract: Background The burden of neurological disorders is large and altered by the HIV epidemic. Objectives We describe the pattern of neurological disorders and their association with HIV infection in adult patients attending a consultant hospital in Northern Tanzania. Methods In this prospective cross-sectional study, we collected data on adult neurological referrals over a 6-year period between 2007–13. The odds of HIV infection, across neurological categories adjusted for age and sex, was calculated. Results Of 2037 participants, 54.8% were male and 45.2% were female. The median age of participants was 43 years. The results for HIV screening were available for 992/2037 (48.7%) patients, of whom 306 (30.8%) were seropositive. The most frequent neurological disorders were cerebrovascular disease (19.9%), paraplegia (13.6%), and peripheral neuropathies (8%). Taken together CNS infection accounted for 278/2037 (13.6%). The adjusted odds (aOR) of HIV infection was highest amongst infections; brain abscesses (aOR 107, 95% CI 35.1–470.4) and meningitis/encephalitis (aOR 40.1, 95% CI 13.6–172.9), but also raised in cerebrovascular disease, paraplegia, peripheral neuropathies, cranial nerve palsies, seizures, cerebllar disorders, movement disorders, motor neuron disease and headache. Conclusion The main pattern of neurological disorders in Northern Tanzania is presented. The odds of HIV infection was highest in CNS infections and in a wide range of non-communicable neurological disorders.
1 citations
TL;DR: In this article , the authors presented a case of an eight-year-old Tanzanian boy who sustained penetrating trauma to his palate developing an ischemic stroke of his right middle cerebral artery territory.
Abstract: Pediatric stroke is uncommon. A traumatic cause of pediatric ischemic stroke is even rarer. Ischemic stroke due to intraluminal thrombus can be acutely treated with thrombolysis but various factors in sub-Saharan Africa make this unfeasible. We present a case of an eight-year-old Tanzanian boy who sustained penetrating trauma to his palate developing an ischemic stroke of his right middle cerebral artery territory.
TL;DR: In this article , the authors described a patient with a paraparesis after start of tuberculosis (TB) treatment and confirmed the diagnosis of central nervous system tuberculosis immune reconstitution inflammatory syndrome based on the history of recurring episodes of leg weakness after initiating TB treatment coupled with the confirmation of CNS TB.
Abstract: In sub-Saharan Africa (SSA) central nervous system (CNS) infections in patients with HIV/AIDS are a major cause of HIV-related mortality and morbidity. We describe a patient with a paraparesis after start of tuberculosis (TB) treatment. The patient had stage IV HIV and was not on antiretroviral therapy. Past history revealed two previous attempts to start TB treatment also complicated with the onset of bilateral lower limb weakness and numbness. MRI showed a cervical longitudinal transverse myelitis. LP showed slight inflammatory changes with positive GeneXpert, consistent with CNS TB. We made a diagnosis of central nervous system tuberculosis immune reconstitution inflammatory syndrome (CNS-TB IRIS) based on the history of recurring episodes of leg weakness after initiating TB treatment coupled with the confirmation of CNS TB. IRIS is a complex disease spectrum and should be considered in immunosuppressed patients with new or worsening symptoms upon initiation of treatment for opportunistic infections, even in patients without antiretroviral therapy.