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. 2021 Nov:210:107003.
doi: 10.1016/j.clineuro.2021.107003. Epub 2021 Oct 23.

Contemporary trends in HIV-associated neurocognitive disorders in Ghana

Fred Stephen Sarfo  1 , Gloria Kyem  2 , Shadrack Osei Asibey  2 , Raelle Tagge  3 , Bruce Ovbiagele  4
Affiliations

Contemporary trends in HIV-associated neurocognitive disorders in Ghana

Fred Stephen Sarfo et al. Clin Neurol Neurosurg. 2021 Nov.

Abstract

Background: Widespread introduction of early combination antiretroviral therapy (cART) for People Living with HIV (PLWH) will influence the burden, profile, and trajectory of HIV-associated neurocognitive disorders (HAND) in the 21st century.

Objectives: To assess the prevalence and trajectory of HAND among PLWH in a Ghanaian tertiary medical center.

Methods: We analyzed the dataset of a study involving PLWH established on cART (n = 256) and PLWH not initially on cART (n = 244). HIV-negative individuals (n = 246) served as normative controls for neurocognitive assessments. HAND was defined according to the Frascati criteria into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD) at enrollment and at month 12. Multivariate logistic regression models were fitted to identify factors associated with HAND.

Results: Among PLWH on cART, 21.5%, 3.5% and 0.0% had ANI, MND and HAD respectively compared with 20.1%, 9.8% and 2.0% among PLWH cART naïve, p < 0.0001. Overall, 71.6%, 20.8%, 6.6% and 1.0% had no cognitive impairment, ANI, MND and HAD at baseline. Among participants who completed month 12 follow-up, 55.2% had no cognitive impairment, 43.5%, 1.2%, 0.0% had ANI, MND and HAD respectively, p < 0.0001. Adjusted odds ratio (95% CI) of six independent predictors of HAND at month 12 were no education (3.29;1.81-6.00), stage 4 disease (4.64;1.37-15.69), hypertension (2.28;1.10-4.73), nevirapine use (2.05;1.04-4.05), baseline viral load (0.66;0.56-0.77), and cigarette use (0.10; 0.03-0.42).

Conclusion: Most Ghanaian patients in the post-cART era with HAND had mild neurocognitive impairments. The impact of hypertension on progression of HAND warrants further evaluation in our settings.

Keywords: Africa; Anti-retroviral therapy; HIV-associated dementia; Progression; Risk factors.

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Conflict of interest statement

Conflicts of interest: none

Figures

Figure 1.
Figure 1.
Prevalence of HAND Spectrum at baseline and month 12 among PLWH in Ghana
FIGURE 2:
FIGURE 2:
PROGRESSION ACROSS HIV ASSOCIATED NEUROCOGNITIVE DISORDERS SPECTRUM
See this image and copyright information in PMC

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