Neurocognitive and mental health outcomes and association with quality of life among adults living with HIV: a cross-sectional focus on a low-literacy population from coastal Kenya

Abstract

ObjectivesOur aim was to compare the neurocognitive performance and mental health outcome of adults living with HIV on antiretroviral therapy with that of community controls, all of low literacy. Furthermore, we also wanted to explore the relationship of these outcomes with quality of life among adults living with HIV.Study designThis was a descriptive cross-sectional study.SettingThe study was conducted in Kilifi County, a region located at the Kenyan coast.ParticipantsThe participants consisted of a consecutive sample of 84 adults living with HIV and 83 randomly selected community controls all with ≤8 years of schooling. All participants were assessed for non-verbal intelligence, verbal working memory and executive functioning. The Major Depression Inventory and a quality of life measure (RAND SF-36) were also administered.ResultsUsing analysis of covariance, we found no statistically significant group differences between adults living with HIV and community controls in all the neurocognitive tests except for a marginal difference in the non-verbal intelligence test (F (1, 158)=3.83, p=0.05). However, depressive scores of adults living with HIV were significantly higher than those of controls (F (1, 158)=11.56, p<0.01). Also, quality of life scores of adults living with HIV were significantly lower than those of controls (F (1, 158)=4.62, p=0.03). For the HIV-infected group, results from multivariable linear regression analysis showed that increasing depressive scores were significantly associated with poorer quality of life (β=−1.17, 95% CI −1.55 to –0.80; p<0.01).ConclusionOur findings suggest that adults of low-literacy levels living with HIV and on antiretroviral medication at the Kenyan coast do not have significant cognitive deficits compared with their uninfected counterparts. However, their mental health, compared with that of HIV-uninfected adults, remains poorer and their quality of life may deteriorate when HIV and depressive symptoms co-occur.

Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya

“…A researcher-developed sociodemographic questionnaire was used to capture participant’s age, sex, marital status, educational level, employment status, and people with whom they were living with. Additionally, an asset index form previously used in this setting [10] was used to gather information on disposable assets owned by participants as an indicator of their socioeconomic status.…”

“…Depression has deleterious consequences on the wellbeing and overall health of PLWHA. It may lead to alteration of economic productivity [8], reduced cART adherence [9], and poor quality of life [10]. Studies from SSA reported that depression is associated with poorer overall health status [11], increases the risk for suicidality [12], leads to faster disease progression and increased mortality [8].…”

Bioenergetic adaptations to HIV infection. Could modulation of energy substrate utilization improve brain health in people living with HIV-1?

“…With ART, PLWH have the potential to live near normal life spans, notwithstanding preexisting comorbid conditions or complications that develop over time. Functional cognitive impairments in PLWH on ART are less frequent and less severe (Nyongesa et al, 2018;Sacktor et al, 2001); current estimates suggest that 15-20% of PLWH exhibit functional cognitive impairment that impacts activities of daily living (Heaton et al, 2010;Robertson et al, 2007;Woods et al, 2009). An additional 25-30% are reported to have a milder form of cognitive impairment that does not impact activities of daily living (Goodkin et al, 2001;Woods et al, 2009), although these individuals are more likely to progress to symptomatic cognitive impairment (Grant et al, 2014).…”

Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review

“… 4 5 Secondary to both biological and psychosocial factors, people living with HIV are at an increased risk of experiencing poor mental health 6 7 which negatively impacts on their health-seeking behaviours, adherence to antiretroviral treatments 8 and quality of life. 9 The prevalence of common mental disorders is also significantly higher among people living with HIV, irrespective of them being on ART, and is further impounded by stigma. 10 There is also a known bidirectional relationship between HIV and mental health, worsened by associated health and social inequalities.…”