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https://doi.org/10.1016/j.clineuro.2021.107003
Copy DOIJournal: Clinical Neurology and Neurosurgery | Publication Date: Oct 23, 2021 |
Citations: 3 | License type: publisher-specific-oa |
BackgroundWidespread introduction of early combination antiretroviral therapy (cART) for People Living with HIV (PLWH) will influence the burden, profile, and trajectory of HIV-associated neurocognitive disorders (HAND) in the 21st century. ObjectivesTo assess the prevalence and trajectory of HAND among PLWH in a Ghanaian tertiary medical center. MethodsWe analyzed the dataset of a study involving PLWH established on cART (n = 256) and PLWH not initially on cART (n = 244). HIV-negative individuals (n = 246) served as normative controls for neurocognitive assessments. HAND was defined according to the Frascati criteria into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD) at enrollment and at month 12. Multivariate logistic regression models were fitted to identify factors associated with HAND. ResultsAmong PLWH on cART, 21.5%, 3.5% and 0.0% had ANI, MND and HAD respectively compared with 20.1%, 9.8% and 2.0% among PLWH cART naïve, p < 0.0001. Overall, 71.6%, 20.8%, 6.6% and 1.0% had no cognitive impairment, ANI, MND and HAD at baseline. Among participants who completed month 12 follow-up, 55.2% had no cognitive impairment, 43.5%, 1.2%, 0.0% had ANI, MND and HAD respectively, p < 0.0001. Adjusted odds ratio (95% CI) of six independent predictors of HAND at month 12 were no education (3.29;1.81–6.00), stage 4 disease (4.64;1.37–15.69), hypertension (2.28;1.10–4.73), nevirapine use (2.05;1.04–4.05), baseline viral load (0.66;0.56–0.77), and cigarette use (0.10; 0.03–0.42). ConclusionMost Ghanaian patients in the post-cART era with HAND had mild neurocognitive impairments. The impact of hypertension on progression of HAND warrants further evaluation in our settings.
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