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- Title
Risk factors for symptomatic HIV-associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania.
- Authors
Eaton, Patrick; Lewis, Thomas; Kellett‐Wright, Johanna; Flatt, Aidan; Urasa, Sarah; Howlett, William; Dekker, Marieke; Kisoli, Aloyce; Rogathe, Jane; Thornton, Jessica; McCartney, Judith; Yarwood, Vanessa; Irwin, Charlotte; Mukaetova‐Ladinska, Elizabeta B.; Akinyemi, Rufus; Gray, William K.; Walker, Richard W.; Dotchin, Catherine L.; Makupa, Philip C.; Quaker, Andrew‐Leon S.
- Abstract
<bold>Objectives: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
TANZANIA; SUB-Saharan Africa; OLDER people; NEUROLOGIC examination; CENTRAL nervous system; HIV seroconversion; LIVING alone; ADULTS
- Publication
International Journal of Geriatric Psychiatry, 2020, Vol 35, Issue 10, p1198
- ISSN
0885-6230
- Publication type
journal article
- DOI
10.1002/gps.5357