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Ophthalmic disease in people living with HIV (PLWH) and at-risk controls in Sub-Saharan Africa was evaluated. PLWH were more likely to have ophthalmic disease at enrollment, but there was no difference in incidence once enrolled.

BackgroundMedication adherence is a critical issue in achieving viral suppression targets, particularly in resource-limited countries. As HIV-related cognitive impairment (CI) impacts adherence, we examined frequency and predictors of CI in the African Cohort Study.SettingCross-sectional examination of enrollment data from President's Emergency Plan for AIDS Relief supported clinic sites.MethodsIn a 30-minute cognitive assessment, CI was defined as -1SD on 2 tests or -2SD on one, as compared with 429 controls. We performed univariable and multivariable logistic and linear models examining clinical and demographic factors associated with CI and global neuropsychological performance (NP-6).ResultsTwo thousand four hundred seventy-two HIV+ participants from Kenya (n = 1503), Tanzania (n = 469), and Uganda (n = 500). The mean (SD) age was 39.7 (10.7) years, and 1452 (59%) were women. The majority reported completing or partially completing primary school (n = 1584, 64%). Mean (SD) current and nadir CD4 count were 463 (249) and 204 (221) cells/mm, respectively; 1689 (68%) were on combination antiretroviral therapy. Nine hundred thirty-nine (38%) HIV+ versus 113 (26%) HIV- individuals showed CI: (P < 0.001). We found significant effects of literacy [odds ratio (OR): 0.3; 95% CI: 0.2 to 0.4; P < 0.001] and World Health Organization stage 4 (OR: 1.5; 95% CI: 1.0 to 2.q; P = 0.046) on CI. Tanzanians (OR: 3.2; 95% CI: 2.4 to 4.3; P < 0.001) and Kenyans (OR: 2.0; 95% CI: 1.6 to 2.6; P < 0.001) had higher risk of CI compared with Ugandans. Results were relatively unchanged in predictive models of NP-6, with the only difference being an additional significant effect of current CD4 cell count (coeff: 0.0; 95% CI: 0.0 to 0.0; P = 0.005).ConclusionsLiteracy, country, World Health Organization stage, and current CD4 cell count were associated with increased risk of cognitive dysfunction. Our findings help optimize care practices in Africa, illustrating the importance of strategies for early and effective viral-immunological control.

Objective The International HIV Dementia Scale (IHDS) was developed as a tool to detect HIV-dementia in both industrialized and resource-limited settings. Studies employing the IHDS have produced mixed results, with recent data suggesting unusually high rates of dementia among Ugandans. This study aimed to define the performance characteristics of the IHDS in three African countries. Design Cross-sectional study. Methods We recruited 2208 HIV-infected and 429 HIV-uninfected individuals from East Africa (Kenya n = 1384; Tanzania n = 368; Uganda n = 456) who underwent testing with the IHDS and a 30-min neuropsychological testing battery. Cognitive impairment was defined as -1SD on two of six tests or -2SD on one test compared with demographically matched controls stratified by age and education. We examined predictive capacity of the IHDS to detect cognitive impairment using receiver-operator characteristic (ROC) curve analysis. Results The mean (SD) ages of the HIV-infected and HIV-uninfected groups were 39.7 (10.7) and 37.4 (10.4), respectively. Among HIV-infected individuals, 1508 (68%) were on combination antiretroviral therapy (cART), 1298 (61%) had plasma viral load less than 500 copies/ml and 884 (38%) met criteria for cognitive impairment. Using the customary IHDS cut-off of 10, 1136 (83%) of the HIV-infected participants met criteria for dementia resulting in 91% sensitivity but only 17% specificity. A modified cut-off score of 8 derived from the ROC resulted in low sensitivity (56%) and specificity (64%). Conclusion The IHDS has poor performance characteristics for the identification of cognitive impairment in East Africa. Cultural-informed and sensitive screening tests are needed to detect mild cognitive dysfunctions in developing countries.