The Profile of Neurocognitive Impairment Amongst HIV Patients in a Southeastern Nigerian Tertiary Hospital

Abstract

Abstract Background The human immunodeficiency virus (HIV) is a neurotropic virus and one of its known effects on the nervous system is HIV Associated Neurocognitive Disorder (HAND). Method This was a cross-sectional prospective study carried out in a tertiary hospital in Southeastern Nigeria using a neuropsychological test battery drawn from the World Health Organization/University of California, Los Angeles test battery (WHO/UCLA). The performance of ninety-two HIV positive patients, divided into thirty-eight combined antiretroviral therapy (cART) experienced and fifty-four cART naïve patients, was compared with those of ninety-two HIV negative subjects. Sociodemographic data was collected from both arms and neuropsychological testing administered. The HIV positive patients also had blood samples collected for parked cell volume (PCV), CD4 count and HIV RNA viral load. The raw scores of the HIV positive patients were converted to standardized Z scores using the mean and standard deviation for each domain of the test battery derived from sex, age and education matched the HIV negative subjects. Neurocognitive impairment was defined by Z-scores greater than 1 SD and 2 SD for mild and moderate to severe cognitive impairment respectively in at least two neurocognitive domains of the neuropsychological test battery. Results The prevalence of neurocognitive impairment was 76.1% (mild cognitive impairment was 44.1% and moderate/severe cognitive impairment was 31.5%); and HIV patients had poorer performance on the auditory verbal learning test (p = 0.01); the finger tapping for both the dominant and non-dominant hands (p < 0.001); the WAIS block design (p < 0.001); the WAIS digit symbol (p < 0.001); grooved pegboard, dominant hand (p = 0.03); the verbal fluency, names and animals (p = 0.02 and p = 0.001 respectively); the trail making test A (p < 0.001); and the timed gait (p < 0.001). The differences in the performance of the HIV positive patients on cART and those yet to commence cART was not statistically significant. Univariate analysis did not reveal any association between cognitive impairment and sex (p = 0.75), age (p = 0.26), and the level of education (p = 0.057) of the HIV positive subjects; and there was also no relationship with the parked cell volume (p = 0.42), viral load (p = 0.48), CD4 count (p = 0.69), and duration of diagnosis for patients who were already on cART (p = 0.84). Conclusion HIV-associated neurocognitive impairment is still common in HIV patients and its presence can be ascertained better with neuropsychological testing.