Risk factors for symptomatic HIV‐associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania

Abstract

Objectives HIV‐associated neurocognitive disorder (HAND), although prevalent, remains a poorly researched cause of morbidity particularly in sub‐Saharan Africa (SSA). We aimed to explore the risk factors for HAND in people aged 50 and over under regular follow‐up at a government HIV clinic in Tanzania. Methods HIV‐positive adults aged 50 years and over were approached for recruitment at a routine HIV clinic appointment over a 4‐month period. A diagnostic assessment for HAND was implemented, including a full medical/neurological assessment and a collateral history from a relative. We investigated potential risk factors using a structured questionnaire and by examination of clinic records. Results Of the cohort (n = 253), 183 (72.3%) were female and the median age was 57 years. Fifty‐five individuals (21.7%) met the criteria for symptomatic HAND. Participants were at a greater risk of having symptomatic HAND if they lived alone [odds ratio (OR) = 2.566, P = .015], were illiterate (OR 3.171, P = .003) or older at the time of HIV diagnosis (OR = 1.057, P = .015). Age was correlated with symptomatic HAND in univariate, but not multivariate analysis. Conclusions In this setting, HIV‐specific factors, such as nadir CD4 count, were not related to symptomatic HAND. The “legacy theory” of early central nervous system damage prior to initiation of anti‐retroviral therapy initiation may contribute, only in part, to a multifactorial aetiology of HAND in older people. Social isolation and illiteracy were associated with symptomatic HAND, suggesting greater cognitive reserve might be protective.

Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

“…27 28 46 48 51 54 55 58 Among sociodemographic variables, older age, 27 54 declining socioeconomic status, 55 being unemployed, 46 being female, 28 58 HIV status disclosure 48 and urban residency 58 were associated with an elevated risk of depression while being married, employed (full-time or part-time work), 54 old age, 51 higher educational attainment 48 and belonging to the highest wealth quintile 28 were associated with reduced levels of depression. However, in some studies, household wealth quintile, education levels, 51 and age 25 were not significant correlates of depression. In other studies, being a current/former smoker, 46 increasing disability scores, decreasing mean handgrip strength, reported back pain, not having hypertension, 55 HIV stigma 48 and caregiving (for adult children) 58 were significantly associated with elevated levels of depression.…”

“…Only eight studies examined the health outcomes of interest using an exclusively HIV infected older sample. 25 33 40 45-49 Eighteen other studies used HIV uninfected older adults as comparison groups, while the rest included HIV infected young adults (the ages varied extensively).…”

“…The correlates of cognitive function/impairment were reported in seven studies. The key predictors of reduced cognitive function were mainly sociodemographic: older age (≥50 years), 21 40 53 60 living alone, 25 being illiterate or having low formal education level, 25 53 being older at the time of HIV diagnosis, 25 being female, unmarried and having low socioeconomic status 53 were associated with a higher risk of impairment. However, in some studies, the effects of age, education and marital status were not significant.…”

Dementia Risk and Prevention in Low and Middle-income Country Settings – Focus on Tanzania Mainland

“…The last risk factor is mild cognitive impairment. It has been established that human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is triggered when individuals are socially isolated (Eaton et al, 2020). More on the subject, the recent study by accounted for HAND prevalence in Tanzania.…”

HIV Associated Neurocognitive Disorders Subsidence Through Citalopram Addition in Anti-retroviral Therapy (HANDS-CARE): A Concept Note

“…The Burden of HAND in Sub-Saharan Africa About 11.3 million HIV/AIDS patients in SSA are reported to be affected by HAND (10,11), with approximately half of those affected reported to have either symptomatic MND or HAD (12). Given suggestions that the above estimates are conservative (13), the burden of HAND in SSA is likely to rank among the highest of any region in the World.…”