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Risk factors for symptomatic HIV-associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania

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journal contribution
posted on 23.03.2021, 15:58 by P Eaton, T Lewis, J Kellett-Wright, A Flatt, S Urasa, W Howlett, M Dekker, A Kisoli, J Rogathe, J Thornton, J McCartney, V Yarwood, C Irwin, EB Mukaetova-Ladinska, R Akinyemi, WK Gray, RW Walker, CL Dotchin, PC Makupa, ALS Quaker, SM Paddick
Objectives
HIV‐associated neurocognitive disorder (HAND), although prevalent, remains a poorly researched cause of morbidity particularly in sub‐Saharan Africa (SSA). We aimed to explore the risk factors for HAND in people aged 50 and over under regular follow‐up at a government HIV clinic in Tanzania.

Methods
HIV‐positive adults aged 50 years and over were approached for recruitment at a routine HIV clinic appointment over a 4‐month period. A diagnostic assessment for HAND was implemented, including a full medical/neurological assessment and a collateral history from a relative. We investigated potential risk factors using a structured questionnaire and by examination of clinic records.

Results
Of the cohort (n = 253), 183 (72.3%) were female and the median age was 57 years. Fifty‐five individuals (21.7%) met the criteria for symptomatic HAND. Participants were at a greater risk of having symptomatic HAND if they lived alone [odds ratio (OR) = 2.566, P = .015], were illiterate (OR 3.171, P = .003) or older at the time of HIV diagnosis (OR = 1.057, P = .015). Age was correlated with symptomatic HAND in univariate, but not multivariate analysis.

Conclusions
In this setting, HIV‐specific factors, such as nadir CD4 count, were not related to symptomatic HAND. The “legacy theory” of early central nervous system damage prior to initiation of anti‐retroviral therapy initiation may contribute, only in part, to a multifactorial aetiology of HAND in older people. Social isolation and illiteracy were associated with symptomatic HAND, suggesting greater cognitive reserve might be protective.

Funding

Grand Challenges Canada. Grant Number: 0086‐04

Newcastle University Masters by Research Programme

Northumbria Healthcare NHS Foundation Trust

History

Citation

International Journal of Geriatric Psychiatry, Volume 35, Issue 10, October 2020, pp. 1198-1208

Author affiliation

Department of Neuroscience, Psychology and Behaviour, College of Life Sciences

Version

VoR (Version of Record)

Published in

International Journal of Geriatric Psychiatry

Volume

35

Issue

10

Pagination

1198-1208

Publisher

Wiley

issn

0885-6230

eissn

1099-1166

Acceptance date

04/06/2020

Copyright date

2020

Available date

23/03/2021

Spatial coverage

England

Language

eng

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