Abstract
Background Cognitive impairment among human immunodeficiency virus (HIV) infected patients can lead to treatment nonadherence, faster progression of the illness, disability, and bed ridden state if we fail to detect it early. However, there is scarcity of previous published studies in Ethiopia on the assessment of cognitive impairment among HIV-positive patients. Hence, this study aimed to determine the prevalence and associated factors of cognitive impairment among HIV-positive patients receiving antiretroviral therapy (ART) at Jimma University Medical Center, Ethiopia. Methods Hospital-based cross-sectional study was conducted among 328 HIV-positive patients attending Jimma University Medical Center, Ethiopia. Data were collected from a face-to-face interview and review of medical records using semistructured questionnaire. Validated International HIV Dementia Scale (IHDS) was used to screen for cognitive impairment. Data was analyzed using SPSS version 20. Results A total of 328 (191 females and 137 males) HIV-positive patients were included in the study with a response rate of 97.04%. The prevalence of cognitive impairment among HIV-positive patients was 35.7%. Factors significantly associated with cognitive impairment were age group of 41−64 years (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI] (1.3, 7.4)], plasma HIV-1 RNA load between 1.7log10 and 3log10 copies/ml [AOR = 2.2, 95% CI (1.1,4.3)] and ≥ 3log10 copies/ml [AOR = 7.5, 95% CI (2.6, 21.5)], khat chewing [AOR = 4.4, 95% CI (2.3, 8.3)], and clinical stage III of the disease [AOR = 5.6, 95% CI (1.7, 19.2)]. Conclusion Despite the use of ART, the burden of cognitive impairment among HIV patients was high. Older age, khat chewing, advanced stage of the disease, and higher viral load were the independent factors associated with cognitive impairment. Thus, continuous screening of cognitive impairment, identification of the possible risk factors, and proper management strategy should be designed.
Highlights
HIV has emerged as a major threat to world health since the start of the epidemic and has challenged scientists and clinicians to combat its vast and devastating effects that led to the death of 1.5 million people from acquired immunodeficiency syndrome (AIDS) related illnesses in 2015 alone [1]
The introduction of ART drugs has prolonged the survival of HIV-positive patients, neurological complications of the disease have remained a great source of morbidity, which can lead to treatment nonadherence, faster progression of the illness, and disability [2, 3]
Subtypes A and D strains are predominant in Kenya, while subtype C strain is common in Ethiopia, and HIV-associated cognitive impairment has been observed to be relatively higher in clade types B and C HIV infection [18, 22]
Summary
HIV has emerged as a major threat to world health since the start of the epidemic and has challenged scientists and clinicians to combat its vast and devastating effects that led to the death of 1.5 million people from acquired immunodeficiency syndrome (AIDS) related illnesses in 2015 alone [1]. the introduction of ART drugs has prolonged the survival of HIV-positive patients, neurological complications of the disease have remained a great source of morbidity, which can lead to treatment nonadherence, faster progression of the illness, and disability [2, 3]. In Ethiopia, a study conducted among HIV-positive participants showed that the prevalence of HIV-associated dementia was 33.3% [7]. There is scarcity of previous published studies in Ethiopia on the assessment of cognitive impairment among HIV-positive patients. This study aimed to determine the prevalence and associated factors of cognitive impairment among HIV-positive patients receiving antiretroviral therapy (ART) at Jimma University Medical Center, Ethiopia. Hospital-based cross-sectional study was conducted among 328 HIV-positive patients attending Jimma University Medical Center, Ethiopia. Factors significantly associated with cognitive impairment were age group of 41−64 years (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI] (1.3, 7.4)], plasma HIV-1 RNA load between 1.7log and 3log copies/ml [AOR = 2.2, 95% CI (1.1,4.3)] and ≥ 3log copies/ml [AOR = 7.5, 95% CI (2.6, 21.5)], khat chewing [AOR = 4.4, 95% CI (2.3, 8.3)], and clinical stage III of the disease [AOR = 5.6, 95% CI (1.7, 19.2)]. Continuous screening of cognitive impairment, identification of the possible risk factors, and proper management strategy should be designed
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