Background:  The prevalence of HIV-related neurocognitive impairment (NCI) in the Asia Pacific region is unknown and reports suggest that HIV dementia (HIVD) and symptomatic peripheral neuropathy (PN) are uncommon. Asia Pacific NeuroAIDS Consortium (APNAC) has commenced a cross-sectional study in 10 countries of the Asia Pacific region to determine the prevalence of HIVD, NCI, PN, and central nervous system opportunistic diseases. The study hypothesis is that NCI and PN are prevalent but under-diagnosed. Results from single sites in Indonesia, China, and Malaysia are presented.

Methods:  HIV⁺ outpatients were consecutively screened for NCI, PN, and depression. The NC test battery comprised grooved pegboard, finger tapper, timed gait, and category fluency (animals). NCI was defined as:  normal, all tests ≥1SD; equivocal, ≤1SD on 1 test; mild-moderate, ≤1SD on 2 tests, or ≤2SD on 1 test, up to –4SD total; severe, ≥4SD. Results were compared against U.S. norms for grooved pegboard and finger tapper, and APNAC site norms obtained for timed gait and category fluency. The ACTG PN screening tool was used. PN was defined as: symptoms + vibration at great toes <10 seconds + absent ankle reflexes. Probable PN (pPN) was defined as: symptoms + 1 of the remaining 2 criteria. Language-validated CES-D 20 was used as a depression screen. Patients’ medical data were obtained from case records. Student t-tests and tests for comparison of proportions were used.

Results:  We evaluated 129 patients:  median age, 31 years; 101 were male (78%); median CD4 cell count 147/mL; prior AIDS, 80 patients (62%); HAART, 99 patients (77%), 36% currently using didanosine, stavudine, both or dideoxycytidine (d-drugs); substance use in past 6 months, 55 (43%). Mild-moderate and severe NCI were found in 62 (48%) and 30 (23%) patients, respectively. PN and pPN were found in 7 (5.4%) and 59 (46%) patients, respectively. Of the total, 32% reached the CES-D cutoff. Patients with severe NCI were significantly likelier to have lower CD4 cell counts than those without NCI (p <0.05), but weren’t likelier to be depressed or report substance use. Patients with pPN were significantly likelier to have lower CD4 cell counts, use d-drugs and be depressed than those without PN (p <0.05). PN pain relief and antidepressants were prescribed for <5% of patients.

Conclusions:  HIV-related mild-moderate and severe NCI, symptomatic PN, and depression are common in HIV-infected outpatients at sites in Indonesia, China, and Malaysia. These conditions are largely under-diagnosed and require further study.