Search

HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943–0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation. [ABSTRACT FROM AUTHOR]

Objective: To determine the influence of major depressive disorders (MDD) on the cognitive function of adults living with HIV and the prevalence of neurocognitive impairment and major depressive disorders. Methods: The study was a cross‐sectional design conducted in a referral hospital in Dodoma region central Tanzania, with a sample of 397 participants attained through systematic sampling. Neurocognitive impairment was assessed by Montreal Cognitive Assessment (MoCA), while MDD was assessed using Mini International Neuropsychiatric Interview (M.I.N.I). Two‐sample independent t‐tests were done to compute the significance of the mean change of MoCA score between those with or without MDD. Univariate and multivariate ordinal logistic regression models were computed to determine the association between MDD and neurocognitive impairment across all cognitive domains. Results: Of 397 recruited participants, 266 (66.00%) met the criteria for neurocognitive disorder and 22 (5.51%) had major depressive disorder. Participants with MDD performed significantly poorer on cognitive testing than those without MDD (mean difference = 3.74, p‐value = 0.0009). Under univariate ordinal regression, impairments in the particular domains of visuospatial‐executive function, attention, language, abstraction and orientation were significantly associated with MDD and abstraction (AOR: 3.922, 95% CI: 1.546–9.947, p = 0.0004) remained significant under multivariable regression. Conclusion: Major depressive disorder may negatively influence neurocognitive performance in both severity and pattern of presentation. Routine screening for depressive symptoms in HIV care can be beneficial for the overall patient's outcome. Systematic and well‐designed studies in the area are crucial for understanding the interaction of neuropsychiatric disorders in the HIV population. [ABSTRACT FROM AUTHOR]

Objectives: Few studies have assessed cognitive impairment among healthy people living with HIV (PLWH) who are stable on antiretroviral treatment (ART) in sub‐Saharan Africa. Methods: We conducted a cross‐sectional study among a random sample of stable adult PLWH from rural Tanzania on ART for more than 1 year and without immunological failure or pre‐existing neurological disease. We evaluated the prevalence and risk factors for neurocognitive impairment (NCI), assessed through neuropsychological tests, functional and depression questionnaires and defined as a mean Z‐score ≤ −1 in two or more cognitive domains. Results: Among 243 participants [median age = 44.3 years (interquartile range: 36–52] and 71% female] we found a rate of NCI of 19.3% (95% confidence interval: 14.8–24.8%). Memory and psychomotor domains demonstrated the highest impairment. Independent predictors of NCI were age and self‐reported alcohol use. Other classical risk factors were not associated with HIV‐associated NCI. Conclusion: Despite effective ART roll‐out, NCI remained a prevalent condition in this healthy rural Tanzanian population of PLWH on ART. Age and alcohol use were key risk factors. [ABSTRACT FROM AUTHOR]