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

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（由申请人提供）： HIV 痴呆 (HIV-D) 和 HIV 相关感觉神经病 (HIV-SN) 是晚期 HIV 感染最常见的神经学表现。 HIV-D 和 HIV-SN 在撒哈拉以南地区的流行。全球大多数艾滋病毒病例居住的非洲在很大程度上尚不清楚。此外，艾滋病毒亚型可能对艾滋病毒疾病进展产生影响，这表明艾滋病毒亚型引起神经系统疾病的能力可能有所不同。 HIV+ 队列乌干达个体：1) 确定未治疗的中度高级免疫抑制的 HIV+ 个体中与 HIV-D 和 HIV-SN 相关的患病率和危险因素，2) 确定未治疗的 HIV+ 个体的神经心理学测试表现和外周血量是否较基线下降神经功能，以及 3) 确定 HIV 亚型在 HIV-D 和 HIV-SN 风险以及 HIV 相关认知障碍和周围神经功能进展方面是否存在差异的初步数据，我们提出了第一个大规模的研究。的前瞻性研究撒哈拉以南非洲地区的 HIV-D 和 HIV-SN 将会提供描述 HIV-D 和 HIV-SN 流行情况和进展的必要数据，这些数据可用于未来与 HIV 相关的认知障碍的应用。目前，对于 CD4 计数为 201-350 个细胞/¿ 的 HIV+ 个体，目前尚不适合开始 HAART我们的提案将提供必要的数据，以确定在撒哈拉以南非洲国家（如乌干达）是否应该改变患有中度免疫抑制和轻度神经认知障碍的 HIV+ 个体开始 HAART 的临床实践参数。 HIV 亚型导致 HIV 相关中枢神经系统和三七总皂甙功能障碍的能力可能有所不同。根据我们的初步研究，该提案还将为乌干达坎帕拉的 HIV 临床医生-科学家提供有关 HIV 相关神经系统疾病研究的培训。根据数据，我们认为 HIV-D 和 HIV-SN 是撒哈拉以南非洲地区晚期 HIV 感染的常见并发症，也是乌干达 HIV+ 个体发病的重要原因，如果及早发现，可以通过抗逆转录病毒药物进行有效治疗治疗和对症治疗。 公共卫生相关性：撒哈拉以南非洲地区的艾滋病毒痴呆 (HIV-D) 和艾滋病毒相关感觉神经病 (HIV-SN) 的流行病学在很大程度上尚不清楚，该地区是全球大多数艾滋病毒病例所在地区。该项目将收集一组艾滋病毒+患者。乌干达个体：1) 确定在未接受治疗且具有中度高级免疫抑制的 HIV+ 个体中与 HIV-D 和 HIV-SN 相关的患病率和危险因素，2) 确定未接受治疗的 HIV+ 个体是否患有 HIV-D 和 HIV-SN神经心理学测试表现和周围神经功能较基线下降，3) 获得初步数据以确定 HIV 亚型在 HIV-D 和 HIV-SN 风险方面是否存在差异。