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. 2020 Feb 1;83(2):157-164.
doi: 10.1097/QAI.0000000000002242.

Frequency and Predictors of HIV-Related Cognitive Impairment in East Africa: The Africa Cohort Study (AFRICOS)

Benedetta Milanini  1 , Isabel Allen  1   2 , Robert Paul  3 , Emmanuel Bahemana  4   5 , Francis Kiweewa  6 , Alice Nambuya  6 , Jonah Maswai  5   7   8   9 , Rither Langat  5   7   8   9 , John Owuoth  5   7   8   10 , Shayanne Martin  1   11 , Katherine Possin  1 , Allahna Esber  5   12 , Christina Polyak  5   12 , Julie A Ake  5 , Victor Valcour  1   13 ; AFRICOS study Team
Affiliations

Frequency and Predictors of HIV-Related Cognitive Impairment in East Africa: The Africa Cohort Study (AFRICOS)

Benedetta Milanini et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Medication adherence is a critical issue in achieving viral suppression targets, particularly in resource-limited countries. As HIV-related cognitive impairment (CI) impacts adherence, we examined frequency and predictors of CI in the African Cohort Study.

Setting: Cross-sectional examination of enrollment data from President's Emergency Plan for AIDS Relief supported clinic sites.

Methods: In a 30-minute cognitive assessment, CI was defined as -1SD on 2 tests or -2SD on one, as compared with 429 controls. We performed univariable and multivariable logistic and linear models examining clinical and demographic factors associated with CI and global neuropsychological performance (NP-6).

Results: Two thousand four hundred seventy-two HIV+ participants from Kenya (n = 1503), Tanzania (n = 469), and Uganda (n = 500). The mean (SD) age was 39.7 (10.7) years, and 1452 (59%) were women. The majority reported completing or partially completing primary school (n = 1584, 64%). Mean (SD) current and nadir CD4 count were 463 (249) and 204 (221) cells/mm, respectively; 1689 (68%) were on combination antiretroviral therapy. Nine hundred thirty-nine (38%) HIV+ versus 113 (26%) HIV- individuals showed CI: (P < 0.001). We found significant effects of literacy [odds ratio (OR): 0.3; 95% CI: 0.2 to 0.4; P < 0.001] and World Health Organization stage 4 (OR: 1.5; 95% CI: 1.0 to 2.q; P = 0.046) on CI. Tanzanians (OR: 3.2; 95% CI: 2.4 to 4.3; P < 0.001) and Kenyans (OR: 2.0; 95% CI: 1.6 to 2.6; P < 0.001) had higher risk of CI compared with Ugandans. Results were relatively unchanged in predictive models of NP-6, with the only difference being an additional significant effect of current CD4 cell count (coeff: 0.0; 95% CI: 0.0 to 0.0; P = 0.005).

Conclusions: Literacy, country, World Health Organization stage, and current CD4 cell count were associated with increased risk of cognitive dysfunction. Our findings help optimize care practices in Africa, illustrating the importance of strategies for early and effective viral-immunological control.

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Conflict of interest statement

Conflicts of interest and source of funding: This research was funded, in part, by the Presidential Emergency Plan for AIDS Relief. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25. These analyses were supported by grant K24MH098759 from NIH and by a cooperative agreement (W81XWH-07-2-0067) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense (DoD). Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70–25. The authors have nothing to declare.

Figures

Figure 1.
Figure 1.. Neuropsychological performance across cognitive measures
Boxplots show z scores for the six cognitive scores and the global score. Plus symbols within each box indicate mean values.
See this image and copyright information in PMC

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