Neurocognitive Disorders in People Living with Human Immunodeficiency Virus Aged 50 Years Old and More in Yalgado Ouédraogo Teaching Hospital

Abstract

A screening of neurocognitive disorders is required in people living with HIV (PLHIV) to improve their care. We aimed to determine their prevalence, their clinical features and identify their associated factors and their nosology in PLHIV aged 50 years old and more. This cross- sectional study from prospective data was carried out in Yalgado Ouedraogo Teaching Hospital, from February to April, 2019. PLHIV aged 50 years old and more were concerned. Those on antiretroviral therapy for at least 6 months were included. Those having a mental dysfunction that did not allow the use of the questionnaire were not included. Baseline data, those relating to HIV, cognitive and daily living capacities assessment, and the nosology of neurocognitive disorders were collected. Daily living capacities were assessed by the Instrumental Activities of Daily Living score, and the cognitive functions by the Mini Mental State Examination. The Chi-square’s or the Fisher’s test and the Student’s test were used to compare respectively the proportions and the means. The factors for which the p-value was less than 0.20 in a bivariate analysis were included into a logistic regression model for a multivariate analysis with a significance of p set at < 0.05. One hundred and two patients were studied: 46 males (45.1%), 56 females (54.9%). The mean age was 57±5.6 years. The main antecedent was alcohol consumption (34.3%). Fifty-nine patients had a nadir of CD4 below 200 cel/µl. Eighty one HIV1 patients had an undetectable updated viral load. The mean duration since HIV diagnosis was 147±62.0 and that of antiretroviral therapy 130±50.0 months. Twenty four (23.5%) patients had neurocognitive disorders, particularly in the fields of attention (100%) and memory (87.5%). A simultaneous disorder in attention, memory and language was the common phenotype (33.3%). It was Asymptomatic Neurocognitive Impairment (66.6%), Minor Neurocognitive Disorders (33.3%). The nosological groups were: “Possible HIV Associated Neurocognitive Disorders (HAND)” (95.83%), “Probable HAND” (4.17%), “Certain HAND” and Secondary neurocognitive disorders (0%). In a bivariate analysis, age ≥ 65, male gender, socio-cultural status 3 (NSC3), opportunistic infection, the nadir of CD4 were the factors with a p-value ≤ 0.20. In a multivariate analysis, age (OR=4.55) and NSC3 (OR=2.55) were associated with neurocognitive disorders with respective p-values 0.03 and 0.04. Neurocognitive disorders are not rare in PLHIV aged 50 years old and more in Burkina Faso. However, appropriate assessment tools have to be developed in accordance with the population’s socio-cultural specifities.