Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. We searched MEDLINE via PubMed, ‘Banque de Donnees de Sante Publique’ and the database of the ‘Institut d’Epidemiologie Neurologique et de Neurologie Tropicale’ from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. In all 144 publications reporting on dementia (n = 49 publications, mainly Alzheimer disease), Parkinsonism (PD, n = 20), HIV-related neurocognitive impairment (n = 47), Huntington disease (HD, n = 19), amyotrophic lateral sclerosis (ALS, n = 15), cerebellar degeneration (n = 4) and Lewy body dementia (n = 1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment’s prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases.

/pdf/epidemiology-of-neurodegenerative-diseases-in-sub-saharan-3fxifdm4ev.pdf

Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review

Movement disorders and AIDS: a review

Objective - To describe differing etiologies and possible anatomoclinical correlates of choreic movements in a series of AIDS patients. Methods - We analyzed the clinical records and neuroimaging data of 5 consecutive AIDS patients who developed choreic movements at our center from January, 1994 to December, 1996. Results - There were 2 cases of focal choreic dyskinesias, 1 of right hemichorea, and 2 of generalized chorea. Onset was acute and febrile in 1 case, and subacute in the other 4. In 1 patient the chorea was the AIDS onset symptom; in another choreic movements were the first neurological symptom following AIDS diagnosis; in 2 patients AIDS had a neurological onset other than chorea; and in the fifth patient buccofacial dyskinesias appeared following the development of bacterial encephalitis. Conclusion - Chorea was associated with cerebral toxoplasmosis in 2 patients, progressive multifocal leukoencephalopathy in 1, subacute HIV encephalopathy in another, and was probably iatrogenic in the last. Chorea is not unusual in AIDS, however the causes are variable and careful neuroradiological and clinical evaluation is required to identify them. AIDS-related disease should be considered in young patients presenting with chorea without a family history of movement disorders.

Chorea in patients with AIDS.

OBJECTIVES: HIV-2 can use a broader range of co-receptors than HIV-1 in vitro, and is less dependent on CD4 for infection. The aim of this study was to detect productive HIV-2 infection in the brain and investigate whether HIV-2 has an expanded tropism for brain cells in vivo, in comparison with HIV-1, which productively infects macrophages/microglia. DESIGN: Brain samples taken at autopsy from eight patients who died from AIDS, six HIV-2 and two HIV-1/HIV-2 dually seropositive, with HIV encephalitis (HIVE), collected in Abidjan, Cote d'Ivoire in 1991, were examined for the presence and localization of productive HIV-2 infection. METHODS: Using immunohistochemistry, the presence of HIV-2 p26 in formalin-fixed, wax-embedded brain tissue sections was investigated. Double-staining with glial fibrillary acidic protein (GFAP), CD45- and CD68-specific antibodies was performed to identify infected cell types. RESULTS: HIV-2 p26 was detected in brain tissue from four of the HIV-2 cases and one of the dually infected individuals. The productively infected cells were either microglia or infiltrating macrophages. CONCLUSIONS: The productively infected cells in the brains of HIV-2 infected individuals are macrophages/microglia. No evidence was found for productive infection of astrocytes, neurons or oligodendrocytes. Thus, the broader in vitro cell tropism, promiscuous coreceptor usage and relative independence of CD4 by HIV-2 compared to HIV-1 does not broaden its range of target cells in the brain.

Productive HIV-2 infection in the brain is restricted to macrophages/microglia.

We report a case of rapidly progressive encephalopathy and generalized chorea due to HIV encephalitis. The patient was a 24-year-old man known to be HIV-seropositive for 4 years. The severity of the movement disorder resulted in rhabdomyolysis. Sepsis developed and he died after a 21-day hospitalization. Pathologic study revealed prominent neuronal loss and gliosis of subcortical regions. Acute encephalopathy with generalized chorea may be a rare consequence of HIV encephalitis.

HIV encephalitis presenting with severe generalized chorea

To describe and evaluate the frequency of neurological and psychiatric manifestations in African patients with AIDS 93 inpatients at the National Hospital Center Bangui were chosen according to the WHO clinical definition of AIDS and were confirmed to be HIV-1 positive (92- 93) or HIV-2 positive (1/93) by Western blot. Patients were given both neurologic and psychiatric examinations. Corticospinal fluid (CSF) analysis was performed in cases where there were neuropsychiatric signs. 11 patients demonstrated neurologic symptoms: 5 had focal processes associated in 2 cases with deep coma 4 had cryptococcal meningitis 1 had peripheral facial paralysis and 1 had abnormal movements. 4 patients presented with clear psychiatric symptoms and CSF analysis was only helpful in the etiologic diagnosis of cryptococcal infection. The mortality rate in these 15 patients was 60% over the course of the 2- month study. In this series neurologic and/or psychiatric symptoms were detected in 16% (15 of 93) of African patients with AIDS. (authors modified) (summaries in FRE ENG)

Manifestations neurologiques et psychiatriques du SIDA en République Centrafricaine

Resume Un cas de syndrome dementiel typique, d'evolution prolongee (30 mois), est decrit chez une patiente centrafricaine de 28 ans qui presente des anticorps anti-HIV2 (Western blot et RIPA) sans reaction croisee en Western blot avec les antigenes de HIV1.

Dementia as the primary manifestation of HIV2 infection in a Central African patient

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Manifestations neurologiques et psychiatriques du SIDA en République Centrafricaine

Dementia as the primary manifestation of HIV2 infection in a Central African patient