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Lookup NU author(s): Dr Lachlan Fotheringham, Dr Rachael LawsonORCiD, Professor Richard Walker, Dr Stella Paddick
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Neuropsychological Society.Objective: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting. Method: This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history. Results: Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background. Conclusions: A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
Author(s): Fotheringham L, Lawson RA, Urasa S, Boshe J, Mukaetova-Ladinska EB, Rogathi J, Howlett W, Dekker MCJ, Gray WK, Evans J, Walker RW, Makupa PC, Paddick S-M
Publication type: Article
Publication status: Published
Journal: Journal of the International Neuropsychological Society
Year: 2024
Pages: epub ahead of print
Online publication date: 20/05/2024
Acceptance date: 17/04/2024
Date deposited: 16/07/2024
ISSN (print): 1355-6177
ISSN (electronic): 1469-7661
Publisher: Cambridge University Press
URL: https://doi.org/10.1017/S1355617724000201
DOI: 10.1017/S1355617724000201
ePrints DOI: 10.57711/z78q-9b41
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