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January 1994

WHO Neuropsychiatric AIDS Study, Cross-sectional Phase IStudy Design and Psychiatric Findings

Author Affiliations

From the Division of Mental Health and Global Programme on AIDS World Health Organization, Geneva, Switzerland (Drs Maj, Starace, and Sartorius); the Department of Psychiatry I, University of Naples, Italy (Drs Maj and Starace); the Division of HIVIAIDS, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Janssen and St. Louis); the Max-Planck Institute for Psychiatry, Munich, Germany (DrZaudig); the Neuropsychiatric Institute, UCLA, Los Angeles, Calif (Drs Satz and Bing); the Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand (Dr Sughondhabirom); the Centre of Neuropsychopathology, University of Kinshasa (Zaire), (Dr Luabeya); the Projet SIDA, Kinshasa, Zaire (Drs Luabeya and St. Louis); the Department of Psychiatry, University of Munich (Germany), (Dr Riedel); the Department of Psychiatry, University of Nairobi(Kenya), (Dr Ndetei); and the Department of Psychobiology, Escola Paulista de Medicina, São Paulo, Brazil (Dr Calil).

Arch Gen Psychiatry. 1994;51(1):39-49. doi:10.1001/archpsyc.1994.03950010039006

Background:  Most available studies on the psychiatric, neuropsychological, and neurological complications of HIV-1 infection and AIDS have been conducted in Western countries, on samples of well-educated, mostly white, homosexual men. Concerns about generalizability of the results of those investigations prompted the WHO to implement the cross-cultural venture called WHO Neuropsychiatric AIDS study.

Methods:  This project aims to assess the prevalence and natural history of HIV-1-associated psychiatric, neuropsychological, and neurological abnormalities in representative subject samples enrolled in the five geographic areas predominantly affected by the HIV-I epidemic. Assessment is made by a data collection instrument including six modules. The intercenter and intracenter reliability in the use of each module has been formally evaluated. The study consists of a cross-sectional phase and a longitudinal follow-up.

Results:  The cross-sectional phase was completed in five centers. This paper reports on the results of psychiatric assessment, which revealed a significantly higher prevalence of current mental disorders in symptomatic seropositive persons compared with seronegative controls among intravenous drug users in Bangkok and homosexuals/bisexuals in São Paulo. The mean global score on the Montgomery-Asberg Depression Rating Scale was significantly higher in symptomatic seropositive individuals than in matched seronegative controls in all centers.

Conclusions:  These results suggest that the significance of the psychopathological complications of symptomatic HIV-1 infection may have been underestimated by previous studies conducted on self-selected samples of well-educated, middle-class, mostly white, homosexual men.