Journal of NeuroVirology
Authors: Peter Kwabena Appiah, Evelyn Yayra Bonney, James Odame Aboagye, Mildred Egyirba Hanson, Christian Obirikorang & George Boateng Kyei
In this study, the authors reviewed the prevalence, diagnostic challenges, and emerging biomarkers of HIV-associated neurocognitive disorder (HAND) in Africa, with an emphasis on improving detection in resource-limited settings. HAND encompasses cognitive, behavioral, and motor impairments that may persist despite effective antiretroviral therapy (ART). The authors conducted a narrative review of 84 publications identified through searches of PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, ScienceDirect, and the Cochrane Library, examining HAND pathogenesis, diagnostic approaches, and potential biomarkers.
The review highlighted the substantial burden of HAND in sub-Saharan Africa, where an estimated 72% of global cases occur. Conventional diagnostic approaches, particularly the Frascati criteria, rely on comprehensive neuropsychological assessments requiring trained specialists and culturally appropriate normative data. Their application is limited by resource constraints, educational and literacy disparities, and potential cultural biases. Persistent central nervous system HIV reservoirs, chronic neuroinflammation, and neuronal injury may contribute to cognitive impairment even among individuals with virologically suppressed HIV.
The authors identified serum intercellular adhesion molecule-5 (ICAM-5), serum adenosine triphosphate (ATP), and plasma neurofilament light chain (NfL) as promising candidate biomarkers. However, these markers require further validation across diverse African populations before routine clinical implementation. The review proposed a three-tier, multimarker diagnostic framework integrating accessible blood-based screening, intermediate clinical assessments, and specialist cerebrospinal fluid biomarker testing.
Overall, the findings underscored the need for validated, culturally appropriate diagnostic tools and accessible biomarkers to facilitate earlier HAND detection and improve neurological care for people living with HIV in Africa.