Abstract
BackgroundHIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls.MethodsInclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning.ResultsTwo-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI.ConclusionsNCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.
Highlights
HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV
While HIV affects many organs [2], HIV enters the brain [3, 4] almost immediately after systemic infection [5]. This can lead to neurocognitive impairment (NCI) known as HIV-associated neurocognitive disorders (HAND) [6,7,8] even among those without detectable virus
Antiretroviral therapy (ART) is widely accessible to people living with HIV (PLWH) and among people who know their HIV status in Zimbabwe 87% are on treatment [9]
Summary
HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. While HIV affects many organs [2], HIV enters the brain [3, 4] almost immediately after systemic infection [5] This can lead to neurocognitive impairment (NCI) known as HIV-associated neurocognitive disorders (HAND) [6,7,8] even among those without detectable virus. PLWH who are virally suppressed because of good medication adherence can have a nearly normal life span [10] Despite this positive outcome NCI has been detected in up to 50% of PLWH who are on ART [3] and it continues to be common in advanced HIV infection [11, 12]. HIV- associated NCI prevalence has been estimated to be between 35 to 70% in Sub-Saharan Africa [13,14,15] Prevalence rates for HIVassociated NCI in Zimbabwe are not known
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