HIV Dementia and Sensory Neuropathy in Uganda

乌干达的艾滋病毒痴呆症和感觉神经病

• 批准号: 7487228
• 负责人: NED C SACKTOR
• 金额: $ 15.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-08 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7487228
• 关键词: AIDS Dementia Complex; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Affect; Africa South of the Sahara; Age; Alzheimer' s Disease; Anti-Retroviral Agents; Behavioral; CD4 Lymphocyte Count; Cells; Clinic; Clinical; Cognitive; Collaborations; Communicable Diseases; Condition; Country; Data; Dementia; Development; Dideoxynucleosides; Disease Progression; Drug usage; Early Diagnosis; Elderly; Epidemic; Epidemiology; Exposure to; Frequencies; Functional disorder; Future; HIV; HIV Infections; HIV diagnosis; HIV-1; Highly Active Antiretroviral Therapy; Immunosuppression; Impaired cognition; Impairment; Individual; Infection; Life; Longitudinal Studies; Measures; Morbidity - disease rate; Motor; Nervous System Physiology; Neurocognitive; Neurologic; Neurologic Manifestations; Neuropathy; Neuropsychological Tests; Patients; Performance; Peripheral Nerves; Peripheral Nervous System; Peripheral Nervous System Diseases; Pharmaceutical Preparations; Plasma; Prevalence; Prospective Studies; Public Health; RNA; Range; Research Infrastructure; Resources; Risk; Risk Factors; Scientist; Score; Symptoms; Tanzania; Therapeutic immunosuppression; Training; Treatment Protocols; Uganda; United States; Vascular Dementia; Virulence; antiretroviral therapy; base; cohort; nervous system disorder; neurovirulence; prevent; research study; sensory neuropathy; AIDS Dementia Complex; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Affect; Africa South of the Sahara; Age; Alzheimer' s Disease; Anti-Retroviral Agents; Behavioral; CD4 Lymphocyte Count; Cells; Clinic; Clinical; Cognitive; Collaborations; Communicable Diseases; Condition; Country; Data; Dementia; Development; Dideoxynucleosides; Disease Progression; Drug usage; Early Diagnosis; Elderly; Epidemic; Epidemiology; Exposure to; Frequencies; Functional disorder; Future; HIV; HIV Infections; HIV diagnosis; HIV-1; Highly Active Antiretroviral Therapy; Immunosuppression; Impaired cognition; Impairment; Individual; Infection; Life; Longitudinal Studies; Measures; Morbidity - disease rate; Motor; Nervous System Physiology; Neurocognitive; Neurologic; Neurologic Manifestations; Neuropathy; Neuropsychological Tests; Patients; Performance; Peripheral Nerves; Peripheral Nervous System; Peripheral Nervous System Diseases; Pharmaceutical Preparations; Plasma; Prevalence; Prospective Studies; Public Health; RNA; Range; Research Infrastructure; Resources; Risk; Risk Factors; Scientist; Score; Symptoms; Tanzania; Therapeutic immunosuppression; Training; Treatment Protocols; Uganda; United States; Vascular Dementia; Virulence; antiretroviral therapy; base; cohort; nervous system disorder; neurovirulence; prevent; research study; sensory neuropathy

DESCRIPTION (provided by applicant): HIV dementia (HIV-D) and HIV-associated sensory neuropathy (HIV-SN) are the most common neurological manifestations of advanced HIV infection. The prevalence of HIV-D and HIV-SN in Sub- Saharan Africa where the majority of HIV cases reside globally is largely unknown. In addition, HIV subtype may have an impact on HIV disease progression, suggesting the possibility that HIV subtypes may differ with respect to their ability to cause neurological disease. The project will assemble a cohort of HIV+ individuals in Uganda: 1) to determine the prevalence of and risk factors associated with HIV-D and HIV-SN among untreated HIV+ individuals with moderate advanced immunosuppression, 2) to determine whether untreated HIV+ individuals decline from baseline in neuropsychological test performance, and peripheral nerve function, and 3) to obtain preliminary data to determine whether HIV subtypes differ with respect to the risk of HIV-D and HIV-SN, and progression of HIV-associated cognitive impairment and peripheral nerve function. We propose one of the first large scale prospective studies of HIV-D and HIV-SN in Sub-Saharan Africa. This proposal will provide the data necessary to characterize the prevalence and progression of HIV-D and HIV-SN, which could be used for future R01 applications. HIV-associated cognitive impairment is currently not an indication for HAART initiation in HIV+ individuals with a CD4 count in the 201-350 cells/¿L range. Our proposal will provide the data necessary to determine if clinical practice parameters for the initiation of HAART among HIV+ individuals with moderate immunosuppression and mild neurocognitive impairment should be changed in countries within Sub-Saharan Africa such as Uganda. Our proposal will examine whether HIV subtypes may differ with respect to their ability to cause HIVassociated CNS and PNS dysfunction. The proposal will also provide training for the HIV clinician-scientists in Kampala, Uganda in research studies of HIV-associated neurological disease. Based upon our preliminary data, we believe that HIV-D and HIV-SN are frequently unrecognized complications of advanced HIV infection in Sub-Saharan Africa, and are a significant cause of morbidity in HIV+ individuals in Uganda, which if identified early, can be treated effectively with antiretroviral therapy and symptomatic therapies. PUBLIC HEALTH RELEVANCE: The epidemiology of HIV dementia (HIV-D) and HIV-associated sensory neuropathy (HIV-SN) in Sub-Saharan Africa where the majority of HIV cases reside globally is largely unknown. The project will assemble a cohort of HIV+ individuals in Uganda: 1) to determine the prevalence of and risk factors associated with HIV-D and HIV-SN among untreated HIV+ individuals with moderate-advanced immunosuppression, 2) to determine whether untreated HIV+ individuals decline from baseline in neuropsychological test performance, and peripheral nerve function, and 3) to obtain preliminary data to determine whether HIV subtypes differ with respect to the risk of HIV-D and HIV-SN.

描述（由适用提供）：HIV痴呆（HIV-D）和与HIV相关的感觉神经病（HIV-SN）是晚期HIV感染的最常见神经系统表现。大多数艾滋病毒案件居住在撒哈拉以南非洲的HIV-D和HIV-SN的患病率在很大程度上是未知的。此外，HIV亚型可能会影响HIV疾病进展，这表明HIV亚型可能在引起神经系统疾病的能力方面有所不同。该项目将在乌干达组成一组HIV+个体：1）确定未经治疗的HIV HIV+个体中与HIV-D和HIV-SN相关的患病率和风险因素的患病率和危险因素和中等高级免疫抑制的个体，2）确定是否在神经心理测试表现和周围性数据中的基线下降的HIV HIV+下降，以及是否能否获得兄弟的基础和3）。 HIV-D和HIV-SN的风险，以及与HIV相关的认知障碍和周围神经功能的进展。我们提出了撒哈拉以南非洲的HIV-D和HIV-SN的首次大规模前瞻性研究之一。该建议将提供表征HIV-D和HIV-SN的患病率和进展所必需的数据，这些数据可用于将来的R01应用程序。目前，与HIV相关的认知障碍不是201-350细胞中CD4计数的HAART启动的指示。我们的建议将提供必要的数据，以确定HIV+个体中HAART的临床实践参数是否适中免疫抑制和轻度的神经认知障碍，例如乌干达诸如乌干达的撒哈拉以南非洲的国家。我们的建议将检查HIV亚型在引起HIVASSAID CNS和PNS功能障碍的能力方面是否可能有所不同。该提案还将为乌干达坎帕拉的艾滋病毒临床科学家提供培训，以研究与HIV相关的神经系统疾病研究。根据我们的初步数据，我们认为HIV-D和HIV-SN经常是撒哈拉以南非洲晚期HIV感染并发症的并发症，这是乌干达艾滋病毒+个体发病率的重要原因，如果早期可以通过抗逆转录病毒疗法和症状治疗有效地治疗。 公共卫生相关性：HIV痴呆症（HIV-D）和与HIV相关的感觉神经病（HIV-SN）的流行病学在撒哈拉以南非洲的大多数HIV病例在全球范围内居住在很大程度上是未知的。该项目将在乌干达组成一组HIV+个体：1）确定未经治疗的HIV HIV+个体中与HIV-D和HIV-SN相关的风险和危险因素的患病率和风险因素的患病率和风险因素的患病率和危险因素，并确定未经治疗的HIV HIV+个体在神经心理测试性能和跨越的数据中是否在基础上降低的hiv HIV+个体，以确定是否能够确定hIV和3）以确定hIV+的个人是否能够确定heriv sublim和3）是否能够确定是否能够确定是否能够确定是否获得heriv seprip and pripery和3）尊重HIV-D和HIV-SN的风险。