Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe

Abstract

Background: HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods: Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results: Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions: NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.

Neurocognitive Disorders in People Living with Human Immunodeficiency Virus Aged 50 Years Old and More in Yalgado Ouédraogo Teaching Hospital

“…The predominant prevalence of the moderate forms of neurocognitive disorders could explain the clinical features, characterized mainly by the impairment in the domains attention and memory. A similar observation was found in Zimbabwe [16]. The disorders in attention, concentration and memory, meaning a subcortical dysfunction, are known to be the initial symptoms at the occurring of neurocognitive disorders.…”

“…Other factors such as the gender, the nadir of CD4, the coinfection HIV-Hepatitis C are reported as risk factors of neurocognitive disorders, but were not found in our study. On the other hand, NSC3 was found to be a factor associated with neurocognitive disorders in our study, everything not having been reported previously, for example in Kenya and Zimbabwe [10,16]. Further analysis could be helpful to explain this result.…”

“…This is within the interval 6% to 69% reported by some authors [13,14]. In Sub Saharan Africa, the prevalence reaches 88% in Kenya [10], 58, 23% in Uganda [14] and 49, 7% in Zimbabwe [16]. The differences could result of the variability in the studies populations, the assessment tools and strategies, and the regional distribution of the neuropathogenic clade D of HIV having a higher potential of causing HAND [17,18].…”

A Meta-Analytic Review of the Effect of Antiretroviral Therapy on Neurocognitive Outcomes in Adults Living with HIV-1 in Low-and Middle-Income Countries

“…The removal of duplicates and application of the inclusion and exclusion criteria at the title and abstract screening stage yielded 128 articles for full-text screening. Of these, 40 studies (see Table 1) met the requirements for quantitative analyses, while seven studies (Do et al, 2018;Ene et al, 2014;Kore et al, 2015;Nyamayaro et al, 2020;Salahuddin et al, 2020;Tsegaw et al, 2017;Yuan et al, 2013) were not included in the meta-analyses due to insufficient data to compute effect sizes or not containing any data to be used for meta-analyses. Of the 40 studies, 24 studies were cross-sectional, 13 studies were longitudinal, and three studies were randomized controlled trials [see Table 1].…”

Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life

“… 40 This suggests that neurocognitive deficits, including memory, limit a person’s ability to reject social stereotypes. 39 , 41 In addition, people with HIV are vulnerable to HIV self-stigma, which translates into a greater level of agreement with negative beliefs associated with their identity. 39 However, studies analysing the relationship between cognitive abilities and HIV self-stigma in this group are scarce.…”