Factors Associated with Neurocognitive Impairment in Treatment Experienced HIV+ Adults from a Tertiary Care Center in Ethiopia

Abstract

Background: Given the improvement in life expectancy of people living with HIV (PLWH) in sub-Saharan Africa, the risk of asymptomatic HIV-associated neurocognitive disorder (HAND) has increased. The study objectives were to investigate the prevalence of HAND and  associated factors among treatment experienced adults in Ethiopia.Methods: A single-center observational cross-sectional study was conducted between December 2019 and June 2020 to investigate  HAND. International HIV dementia scale (IHDS) was used to screen for the disorder. Both descriptive and analytical statistics were used to  analyze the data.Results: Total of 324 PLWH (63% females) who were on combination antiretroviral therapy for median of 144 months (IQR: 108-168) were  investigated. The mean age was 42.5 years (1SD=12.2). The prevalence of HAND was 75.3% and the difference was significantly more in  those above 40 years of age (65.8% vs. 80.7%, p=0.003). Age is the only risk factor identified with multivariable logistic regression analysis.  A linear decrement in the total score of cognitive performance was observed as the patient’s age increase; age was responsible  for 9.4% variation observed in IHDS score (r= -0.31, R2=0.094, p<0.0001). Although statistically not-significant, the trend for  cardiometabolic and behavioral risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol and khat use) was higher in  the group diagnosed with HAND.Conclusion: The occurrence of neurocognitive impairment was more pronounced in individuals aged 40 years and above who were HIV  positive, compared to those below 40 years. Age was found to be an independent predictor of HAND. Cardiovascular and behavioral risk  factors were observed more among patients with HAND compared to no-HAND.