HIV‐associated neurocognitive impairment in stable people living with HIV on ART in rural Tanzania

Abstract

ObjectivesFew studies have assessed cognitive impairment among healthy people living with HIV (PLWH) who are stable on antiretroviral treatment (ART) in sub‐Saharan Africa.MethodsWe conducted a cross‐sectional study among a random sample of stable adult PLWH from rural Tanzania on ART for more than 1 year and without immunological failure or pre‐existing neurological disease. We evaluated the prevalence and risk factors for neurocognitive impairment (NCI), assessed through neuropsychological tests, functional and depression questionnaires and defined as a mean Z‐score ≤ −1 in two or more cognitive domains.ResultsAmong 243 participants [median age = 44.3 years (interquartile range: 36–52] and 71% female] we found a rate of NCI of 19.3% (95% confidence interval: 14.8–24.8%). Memory and psychomotor domains demonstrated the highest impairment. Independent predictors of NCI were age and self‐reported alcohol use. Other classical risk factors were not associated with HIV‐associated NCI.ConclusionDespite effective ART roll‐out, NCI remained a prevalent condition in this healthy rural Tanzanian population of PLWH on ART. Age and alcohol use were key risk factors.

Neuroimmunology of CNS HIV Infection: A Narrative Review

“…Estimates of the prevalence of HIV-associated cognitive impairment have varied widely across the continent but are comparable to other world regions ( 16 , 17 ) and have generally decreased as ART became more widely available ( 18 – 20 ). The prevalence of mild impairment was reported to be between 40 and 55% and moderate to severe impairment between 3 and 25% in two large multi-country cross-sectional and cohort studies using comprehensive neuropsychological test batteries in the African continent [the AIDS Clinical Trials Group 5199 ( 17 , 21 ) and the African Cohort Study ( 22 )], and in several larger studies from South Africa ( 23 ), Malawi ( 24 ), Tanzania ( 25 ) and Zimbabwe ( 26 ). Cognitive development is also impacted in pediatric HIV, where infants and young children with HIV do not perform as well as their HIV-exposed or HIV uninfected peers ( 27 – 30 ).…”

Neurocognitive Impairment and Associated Factors Among People Living with HIV: A Systematic Review and Meta-Analysis of African Studies

“…A total of 22 articles in Africa [9][10][11][12]15,16,[20][21][22][28][29][30][31][32][33][34][35][36][37][38][39][40] that examined NCI and associated factors in 6741 people living with HIV have been included in this study. Regarding the regional distribution, the three articles 16,28,32 were done in Central and South Africa, fifteen 9,11,12,15,[20][21][22][29][30][31][33][34][35]38,40 were from East Africa and four 10,36,37,39 from West Africa.…”

“…Based on the study design, 19 9,10,12,15,16,[20][21][22][28][29][30][31][32][33][34][35][38][39][40] of them were cross-sectional, one cohort, 37 and two casecontrol 11,36 studies. More than half of these studies 10,15,16,21,22,28,30,[32][33][34][35][36]38,40 used IHDS to screen NCI among individuals living with HIV.…”

“…More than half of these studies 10,15,16,21,22,28,30,[32][33][34][35][36]38,40 used IHDS to screen NCI among individuals living with HIV. Two 31,39 used Frascati criteria, three 9,11,12 used GDS, and the remaining three 20,29,37 studies used others (MoCA, WAIS, NR). In addition, nine 15,28,31,32,[34][35][36][37]39 were published from 2010-2015 years, and the remaining thirteen [9][10][11][12]16,[20][21][22]29,30,33,38,40 studies were published from 2016-2020 years (Table 1).…”

“…12 The presence of other AIDS-defining infections or tumors, low haemoglobin concentration, advanced age, female sex, level of education, income level, social support, medical comorbidities, intravenous drug use, and HIV medication adherence, as well as self-reported alcohol use, Khat chewing, lifetime tobacco use, being married, and unmarried status are all associated with cognitive impairment in HIV. [13][14][15][16][17][18][19][20][21][22] However, as noted above, facility-based research was carried out in different parts of the African continent about NCI associated with HIV infection, there are only two systematic reviews and meta-analyses done in Sub-Saharan countries and not for African countries in general. In addition, the determinant factors reported by different researchers were not consistent.…”