Cognitive Reserve and Its Determinants in Newly HIV Diagnosed Antiretroviral-Naive Adults From Periurban and Informal Settlements: Evidence From an HIV Hyperendemic South African Setting.

Abstract

Cognitive reserve (CR), the brain's capacity to resist pathology, plays an essential role in preserving the cognitive health of people living with HIV. Cognitive health differs by the HIV clinical stage, but there are few studies on CR in newly diagnosed antiretroviral treatment (ART)-naive HIV-positive adults to inform early intervention in sub-Saharan Africa. We investigated the CR profile and its determinants among 211 newly diagnosed ART-naive HIV-positive participants from 2 clinics that serve periurban and informal settlement communities in KwaZulu-Natal, South Africa. CR domains in education, work, and leisure were assessed using the Cognitive Reserve Index questionnaire (CRIq). The CR determinants included major depression, substance use, CD4 count, history of head injury/medical comorbidity, in addition to sociodemographic status. Regression models were fitted to investigate relationships between the total/domain scores and their determinants. CRIq-Total scores were concentrated in the low-medium/medium functioning range with no individual in the extreme low or high CR functioning group. The determinants of CRIq-Total and CRIq-Education were older age, higher education attainment, and being employed. For the CRIq-Work domain, we found older age associated with lower CR. Major depression was only associated with lower CRIq-Leisure. ART scale-up will undoubtedly improve the longevity of individuals living with HIV, but we found high degree of suboptimal CR in a relatively young group of newly diagnosed ART-naive HIV-positive individuals from periurban and informal settlement communities. Early intervention focusing on increasing CR especially in socioeconomically vulnerable populations is needed to mitigate HIV-associated neurocognitive impairment and promote long-term healthy independent living.