Risk factors for symptomatic HIV-associated neurocognitive disorder in adults aged 50 and over attending a HIV clinic in Tanzania.
HIV
cognitive impairment
older adults
risk factors
sub-Saharan Africa
Journal
International journal of geriatric psychiatry
ISSN: 1099-1166
Titre abrégé: Int J Geriatr Psychiatry
Pays: England
ID NLM: 8710629
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
27
01
2020
revised:
15
05
2020
accepted:
24
05
2020
pubmed:
5
6
2020
medline:
13
4
2021
entrez:
5
6
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1198-1208Informations de copyright
© 2020 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
Références
Teeraananchai S, Kerr S, Amin J, Ruxrungtham K, Law M. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med. 2017;18(4):256-266.
UNAIDS. 2017 Global HIV statistics [internet]. Fact Sheet 2018 Retrieved on 18 November, 2018 from http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
Hontelez JAC, de Vlas SJ, Baltussen R, et al. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26:S19-30.
Clifford DB, Ances BM. HIV-associated neurocognitive disorder. Lancet Infect Dis. 2013;13(11):976-986.
Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789-1799.
Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky performance status scale: an examination of its reliability and validity in a research setting. Cancer. 1984;53(9):2002-2007.
Simioni S, Cavassini M, Annoni J-M, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010;24(9):1243-1250.
Habib AG, Yakasai AM, Owolabi LF, et al. Neurocognitive impairment in HIV-1-infected adults in sub-Saharan Africa: a systematic review and meta-analysis. Int J Infect Dis. 2013;17(10):e820-31.
Gorman AA, Foley JM, Ettenhofer ML, Hinkin CH, van Gorp WG. Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev. 2009;19(2):186-203.
Valcour V, Shikuma C, Shiramizu B, et al. Higher frequency of dementia in older HIV-1 individuals the Hawaii aging with HIV-1 cohort. Neurology. 2004;63(5):822-827.
Kinai E, Komatsu K, Sakamoto M, et al. Association of age and time of disease with HIV-associated neurocognitive disorders: a Japanese nationwide multicenter study. J Neurovirol. 2017;23(6):864-874.
Heaton RK, Franklin DR, Ellis RJ, et al. HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neurovirol. 2011;17(1):3-16.
Ellis RJ, Badiee J, Vaida F, et al. CD4 nadir is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy. AIDS. 2011;25(14):1747-1751.
McCombe J, Vivithanaporn P, Gill M, Power C. Predictors of symptomatic HIV-associated neurocognitive disorders in universal health care. HIV Med. 2013;14(2):99-107.
Marra CM, Zhao Y, Clifford DB, et al. Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. AIDS. 2009;23(11):1359-1366.
Ku N, Lee Y, Ahn J, et al. HIV-associated neurocognitive disorder in HIV-infected Koreans: the Korean NeuroAIDS project. HIV Med. 2014;15(8):470-477.
Smurzynski M, Wu K, Letendre S, et al. Effects of central nervous system antiretroviral penetration on cognitive functioning in the ALLRT cohort. AIDS. 2011;25(3):357-365.
Schweinsburg BC, Taylor MJ, Alhassoon OM, et al. Brain mitochondrial injury in human immunodeficiency virus-seropositive (HIV+) individuals taking nucleoside reverse transcriptase inhibitors. J Neurovirol. 2005;11(4):356-364.
Ciccarelli N, Fabbiani M, Di Giambenedetto S, et al. Efavirenz associated with cognitive disorders in otherwise asymptomatic HIV-infected patients. Neurology. 2011;76(16):1403-1409.
McCutchan JA, Marquie-Beck JA, FitzSimons CA, et al. Role of obesity, metabolic variables, and diabetes in HIV-associated neurocognitive disorder. Neurology. 2012;78(7):485-492.
Vivithanaporn P, Nelles K, Deblock L, Newman SC, Gill MJ, Power C. Hepatitis C virus co-infection increases neurocognitive impairment severity and risk of death in treated HIV/AIDS. J Neurol Sci. 2012;312(1-2):45-51.
Gascón MRP, Vidal JE, Mazzaro YM, et al. Neuropsychological assessment of 412 HIV-infected individuals in Saõ Paulo. Brazil AIDS Patient Care STDS. 2018;32(1):1-8.
Satz P, Morgenstern H, Miller EN, et al. Low education as a possible risk factor for cognitive abnormalities in HIV-1: findings from the multicenter AIDS cohort study (MACS). J Acquir Immune Defic Syndr. 1993;6(5):503-511.
Weber E, Morgan EE, Iudicello JE, et al. Substance use is a risk factor for neurocognitive deficits and neuropsychiatric distress in acute and early HIV infection. J Neurovirol. 2013;19(1):65-74.
Joska JA, Westgarth-Taylor J, Myer L, et al. Characterization of HIV-associated neurocognitive disorders among individuals starting antiretroviral therapy in South Africa. AIDS Behav. 2011;15(6):1197-1203.
Yakasai AM, Gudaji MI, Muhammad H, et al. Prevalence and correlates of HIV-associated neurocognitive disorders (HAND) in northwestern Nigeria. Neurol Res Int. 2015;2015:486960.
Milanini B, Paul R, Bahemana E, et al. Limitations of the international HIV dementia scale in the current era. AIDS. 2018;32(17):2477-2483.
National Guidelines for the Management of HIV and AIDS [Internet]. 2015. Retrieved from https://aidsfree.usaid.gov/sites/default/files/04_11_2016.tanzania_national_guideline_for_management_hiv_and_aids_may_2015._tagged.pdf
Letendre SL, Ellis RJ, Ances BM, McCutchan JA. Neurologic complications of HIV disease and their treatment. Top HIV Med. 2010;18(2):45-55.
Baiyewu O, Smith-Gamble V, Lane KA, et al. Prevalence estimates of depression in elderly community-dwelling African Americans in Indianapolis and Yoruba in Ibadan, Nigeria. Int Psychogeriatrics. 2007;19(4):679-689.
Hergueta T, Baker R, Dunbar GC. The MINI-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IVand ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):2233.
Collingwood C, Paddick S-M, Kisoli A, et al. Development and community-based validation of the IDEA study instrumental activities of daily living (IDEA-IADL) questionnaire. Glob Health Action. 2014;7(1):25988.
Paddick S-M, Lewis EG, Duinmaijer AT, et al. Evaluation of the IDEA (identification and interventions for dementia in elderly AFRICANS) brief cognitive screening tool for identification of DELIRIUM in older hospitalised adults in Tanzania. Alzheimers Dement. 2016;12(7):P364-5.
Gisslén M, Price RW, Nilsson S. The definition of HIV-associated neurocognitive disorders: are we overestimating the real prevalence? BMC Infect Dis. 2011;11(1):356.
Wong MH, Robertson K, Nakasujja N, et al. Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology. 2007;68(5):350-355.
Lawler K, Jeremiah K, Mosepele M, et al. Neurobehavioral effects in HIV-positive individuals receiving highly active antiretroviral therapy (HAART) in Gaborone. Botswana PLoS One. 2011;6(2):e17233.
Valcour V, Yee P, Williams AE, et al. Lowest ever CD4 lymphocyte count (CD4 nadir) as a predictor of current cognitive and neurological status in human immunodeficiency virus type 1 infection-the Hawaii aging with HIV cohort. J Neurovirol. 2006;12(5):387-391.
Becker JT, Kingsley L, Mullen J, et al. Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men. Neurology. 2009;73(16):1292-1299.
Fabbiani M, Ciccarelli N, Tana M, et al. Cardiovascular risk factors and carotid intima-media thickness are associated with lower cognitive performance in HIV-infected patients. HIV Med. 2013 Mar;14(3):136-144.
Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60(4):351-358.
Manji H, Jäger HR, Winston A. HIV, dementia and antiretroviral drugs: 30 years of an epidemic. J Neurol Neurosurg Psychiatry. 2013;84(10):1126-1137.
Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448-460.
UNESCO Institute for Statistics. Adult and Youth Literacy. National, Regional and Global Trends, 1985-2015. 2015. p. 132
Heward J, Stone L, Paddick S-M, et al. A longitudinal study of cognitive decline in rural Tanzania: rates and potentially modifiable risk factors. Int Psychogeriatrics. 2018;30(9):1333-1343.
Alzheimer's disease facts and figures. Alzheimer's & Dementia. Vol 10, 2014. The Netherlands: Elsevier; 2014:e47-92.
Tang Y, Arnold SE, Barnes LL, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007;64(2):234.
Nachega JB, Morroni C, Zuniga JM, et al. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Physicians AIDS Care. 2012;11(3):172-178.
Sacktor N. Changing clinical phenotypes of HIV-associated neurocognitive disorders. J Neurovirol. 2018;24:141-145.
Green DA, Masliah E, Vinters HV, Beizai P, Moore DJ, Achim CL. Brain deposition of beta-amyloid is a common pathologic feature in HIV positive patients. AIDS. 2005;19(4):407-411.
Saylor D, Sacktor N. Cognitive impairment among older individuals with HIV infection. Curr Geriatr Rep. 2016;5(2):63-70.