There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.

Background The ageing of the global HIV‐positive population brings with it the novel challenges of geriatric medicine, such as management of comorbidities including cardiovascular disease and HIV‐associated neurocognitive disorder (HAND). Recent literature from high‐income countries suggests vascular risk factors, which are increasingly prevalent throughout sub‐Saharan Africa (SSA), are stronger predictors of HAND than HIV‐disease severity. There is a paucity of evidence surrounding the association between HAND, vascular risk factors and end‐organ damage (EOD) in older cohorts of people living with HIV (PLWH) in SSA. This study aimed to establish prevalence, and evaluate the relationship between vascular risk factors, EOD and HAND in individuals aged ≥50 receiving HIV treatment in Tanzania Method A systematic sample of outpatients with HIV on combined antiretroviral therapy (cART) were recruited in Kilimanjaro and assessed for vascular risk factors (hypertension, hypercholesterolaemia, diabetes, smoking etc) and markers of vascular EOD (prior myocardial infarction and LVH on ECG, stroke on neurological examination or MRI‐brain, estimated‐glomerular filtration rate and retinal arteriovenous ratio measurements). HAND were defined by AAN criteria following a detailed locally normed neurocognitive assessment battery, neurological and clinical examination and informant history, and will subsequently be confirmed by consensus panel. Result Complete data were available for 145 individuals (mn age 56, 72.7% female). Provisional HAND prevalence was high (64.7%, 31.4% symptomatic) despite well‐managed HIV‐disease (70.5% suppressed viral load). 34.0% of the cohort were hypertensive, 10.5% obese, 33.3% had hypercholesterolaemia, 5.3% had diabetes and 4.6% smoked. Vascular EOD prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (LVH). No significant association was found between vascular factors and HAND. Conversely symptomatic HAND was significantly correlated with lower BMI (p=0.034) and lower total serum cholesterol (p=0.014). Conclusion HAND prevalence was high, however prevalence of vascular risk factors was lower than in recent Tanzanian community studies. The lack of association between vascular factors and HAND does not support the hypothesis that HAND is driven by vascular damage. However, the high prevalence of HAND observed suggests an alternative aetiology within this cohort. Further research is urgently required to explore factors contributing to the high burden of neurocognitive impairment among PLWH in SSA.

Objectives: HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with treated HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity. This hypothesis is yet to be examined in the population ageing with HIV in sub-Saharan Africa. Our aim was to evaluate relationships of VRFs, vascular end organ damage and HAND in individuals aged ≥50 receiving HIV treatment in TanzaniaDesign: Cross sectional observational study, with systematic sampling.Methods: c-ART-treated individuals were assessed for HAND by consensus criteria. Prevalence of VRFs (hypertension, hypercholesterolemia, obesity, diabetes, and smoking) and end organ damage markers (prior myocardial infarction, stroke, left ventricular hypertrophy, estimated-glomerular filtration rate, ankle-brachial pressure index, retinal arteriovenous ratio) were measured. Independent associations of VRFs, end organ damage and HAND were examined by multivariable logistic regression.Results: 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 MI) to 12.5% (LVH). Measured VRFs and end organ damage were not independently associated with HAND, although there was a significant association with lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997).Conclusion: The overall lack of association between vascular risk factors, vascular end organ damage and HAND suggests vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.

Background Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Objectives To evaluate clinical utility of HIV-retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. Methods A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Results Of 129 individuals assessed, 69.8% were visually impairment. Six had suspected HIV retinopathy. HAND prevalence was 66.7%. HIV retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of HIV-retinopathy for HAND was poor (AUROC 0.545–0.617) but specificity and positive predictive value were high. Conclusions Ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.