Author:
Flatt Aidan,Gentry Tom,Kellett-Wright Johanna,Eaton Patrick,Joseph Marcella,Urasa Sarah,Howlett William,Dekker Marieke,Kisoli Aloyce,Rogathe Jane,Henderson Lindsay,Lewis Thomas,Thornton Jessica,McCartney Judith,Yarwood Vanessa,Irwin Charlotte,Mukaetova-Ladinska Elizabeta B.,Akinyemi Rufus,Gray William K.,Walker Richard W.,Dotchin Catherine L.,Quaker Andrew-Leon S.,Makupa Philip C.,Paddick Stella-Maria
Abstract
Abstract
Objectives:
HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
Design:
Longitudinal study
Participants:
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.
Measurements:
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
Results:
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed.
Conclusions:
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
Publisher
Cambridge University Press (CUP)
Subject
Psychiatry and Mental health,Geriatrics and Gerontology,Gerontology,Clinical Psychology
Cited by
8 articles.
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