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HIV-Associated Neurocognitive Disorders: The First Longitudinal Follow-Up of a cART-Treated Cohort of Older People in Sub-Saharan Africa

Lookup NU author(s): Dr Elizabeta Mukaetova-Ladinska, Professor Richard Walker, Dr Catherine Dotchin, Professor Raj KalariaORCiD, Dr Rufus Akinyemi, Dr Stella Paddick


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© 2022 Lippincott Williams and Wilkins. All rights reserved. Background: HIV-associated neurocognitive disorders (HAND) are a highly prevalent chronic complication in older people living with HIV (PLWH) in high-income countries. Although sub-Saharan Africa has a newly emergent population of older combination antiretroviral therapy (cART)-treated PLWH, HAND have not been studied longitudinally. We assessed longitudinal prevalence of HAND and have identified possible modifiable factors in a population of PLWH aged 50 years or older, over 3 years of follow-up. Methods: Detailed neuropsychological and clinical assessment was completed annually in the period 2016-2019 in a systematic sample of cART-treated PLWH in Kilimanjaro, Tanzania. A consensus panel defined HAND using American Academy of Neurology criteria for asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. HIV disease severity and other factors associated with HAND progression, improvement, and stability were evaluated in individuals fully assessed at baseline and in 2019.Results:At baseline, 47% of the cohort (n = 253, 72.3% female individuals) met HAND criteria despite good HIV disease control [Y1 59.5% (n = 185), Y2 61.7% (n = 162), and Y3 57.9% (n = 121)]. Of participants fully assessed at baseline and year 3 (n = 121), HAND remained stable in 54% (n = 57), improved in 15% (n = 16), and declined in 31% (n = 33). Older age and lower education level significantly predicted HAND progression, whereas HIV-specific factors did not. Male sex and shorter cART duration were associated with improvement. Conclusions: In this first longitudinal study characterizing clinical course of HAND in older cART-treated PLWH in sub-Saharan Africa, HAND was highly prevalent with variable progression and reversibility. Progression may be more related to cognitive reserve than HIV disease in cART-treated PLWH.

Publication metadata

Author(s): Spooner R, Ranasinghe S, Urasa S, Yoseph M, Koipapi S, Mukaetova-Ladinska EB, Lewis T, Howlett W, Dekker M, Kisoli A, Gray WK, Walker RW, Dotchin CL, Kalaria R, Lwezuala B, Makupa PC, Akinyemi R, Paddick SM

Publication type: Article

Publication status: Published

Journal: Journal of Acquired Immune Deficiency Syndromes

Year: 2022

Volume: 90

Issue: 2

Pages: 214-222

Print publication date: 01/06/2022

Acceptance date: 02/04/2018

ISSN (print): 1525-4135

ISSN (electronic): 1077-9450

Publisher: Lippincott Williams and Wilkins


DOI: 10.1097/QAI.0000000000002934

PubMed id: 35125473


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