Cognitive differences associated with HIV serostatus and antiretroviral therapy use in a population-based sample of older adults in South Africa

Stephen B Asiimwe,Jen Manne-Goehler,Till Bärnighausen,Livia Montana,Lindsay C Kobayashi,F Xavier Gómez-Olivé,Kathleen Kahn,Chodziwadziwa Whiteson Kabudula,Stephen M Tollman,Ryan G Wagner,M Maria Glymour,Lisa F Berkman,Meagan Farrell

doi:10.1038/s41598-020-73689-7

Abstract

Previous clinical studies have reported adverse cognitive outcomes for people living with HIV (PLWH), but there are no population-based studies comparing cognitive function between older PLWH and comparators without HIV in sub-Saharan Africa. We analyzed baseline data of 40 + years-old participants in “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort. We measured cognition using a battery of conventional instruments assessing orientation, immediate- and delayed-recall, and numeracy (N = 4560), and the Oxford Cognitive Screen [OCS]-Plus, a novel instrument for low-literacy populations, assessing memory, language, visual-spatial ability, and executive functioning (N = 1997). Linear regression models comparing cognitive scores between participants with and without HIV were adjusted for sex, education, age, country of birth, father’s occupation, ever-consumed alcohol, and asset index. PLWH scored on average 0.06 (95% CI 0.01–0.12) standard deviation (SD) units higher on the conventional cognitive function measure and 0.02 (95% CI − 0.07 to 0.04) SD units lower on the OCS-Plus measure than HIV-negative participants. We found higher cognitive function scores for PLWH compared to people without HIV when using a conventional measure of cognitive function but not when using a novel instrument for low-literacy settings.

Highlights

Abbreviations asymptomatic neurocognitive impairment (ANI) Asymptomatic neurocognitive impairment antiretroviral therapy (ART) Antiretroviral therapy diastolic blood pressure (DBP) Diastolic blood pressure dried blood spots (DBS) Dried blood spots FTC Emtricitabine HAALSI Health and aging in Africa: a longitudinal study of an INDEPTH community in South Africa HAD HIV-associated dementia
This study presents, for the first time to our knowledge, a comparison of the cognitive function according to HIV and ART use status in older people in a rural region of sub-Saharan Africa
The comparison was done in groups with similar sociodemographic characteristics, in an HIV hyperendemic community in rural South Africa

Summary

Introduction

Abbreviations ANI Asymptomatic neurocognitive impairment ART Antiretroviral therapy DBP Diastolic blood pressure DBS Dried blood spots FTC Emtricitabine HAALSI Health and aging in Africa: a longitudinal study of an INDEPTH community in South Africa HAD HIV-associated dementia. HAND HIV-associated neurocognitive disorder HDSS Health and socio-demographic surveillance system INDEPTH International network for the demographic evaluation of populations and their health MICE Multiple imputation by chained equations MRC Medical research council OCS-Plus Oxford cognitive screen-plus PLWH People living with HIV PCR Polymerase chain reaction SBP Systolic blood pressure SSA Sub-Saharan Africa 3TC Lamivudine. Previous clinical studies in South Africa reported high prevalence of HAND among PLWH, ranging from 5 35 to 67%6. Some studies reported change in presentation from predominantly motor skills, cognitive speed, and verbal fluency impairment in the pre-ART era, to predominantly memory and executive function impairment in the ART era, suggesting possible domain-specific effects from HIV and/or ART10. Even if ART does not influence cognition overall, identifying domain-specific effects of HIV and/or ART on cognition may advance our understanding of the mechanisms of cognitive impairment, potentially guiding clinical care and future research

Methods

Results

Conclusion