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Title: | Contemporary trends in HIV-associated neurocognitive disorders in Ghana |
Authors: | Sarfo, Fred Stephen Kyem, Gloria Osei Asibey, Shadrack Raelle Tagge, Raelle Tagge Ovbiagele, Bruce |
Keywords: | HIV-associated dementia Progression Risk factors Anti-retroviral therapy Africa |
Issue Date: | Oct-2021 |
Publisher: | Clinical Neurology and Neurosurgery |
Citation: | Clinical Neurology and Neurosurgery, 210 (2021) 107003 |
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. |
Description: | This article is published by Clinical Neurology and Neurosurgery and is also available at https://doi.org/10.1016/j.clineuro.2021.107003 |
URI: | 10.1016/j.clineuro.2021.107003 http://hdl.handle.net/123456789/15662 |
Appears in Collections: | College of Health Sciences
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