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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/15662

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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