Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study.
Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study.
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DOI：
10.1371/journal.pone.0285761
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Nyundo, Azan A.
中科院分区：
文献类型：
--
作者：
Nyundo, Azan A.
尽管取得了进展，抗逆转录病毒治疗的覆盖率有所提高，但艾滋病毒相关神经认知障碍（HAND）仍在继续显现。神经认知障碍是与抗逆转录病毒治疗依从性差和HIV护理保留有关的不良预后的重要预测因子。本横断面研究调查了397名在Dodoma地区转诊医院（DRRH）接受护理和治疗的参与者，并通过系统抽样选择。结合蒙特利尔认知评估（MoCA）、国际HIV痴呆量表（IHDS）和劳顿日常生活工具活动（IADL）评估HIV相关神经认知障碍。使用单变量和多变量逻辑回归确定与HAND相关的因素。在397名参与者中，234名（59.1%）符合HAND的标准，231名（58.2%）包括无症状神经认知障碍（ANI）或轻度神经认知障碍（MND）， 3名（0.76%）HIV相关痴呆（HAD）。在MoCA和IHDS测试中，HAND患者在每个认知领域的表现都明显较差。在多变量回归分析中，55岁及以上年龄的调整优势比（AOR）： 3.5 (95%CI: 1.1, 11.6), p = 0.041；女性（AOR）： 2.7 (95%CI: 1, 6, 4.5), p<0.001与HAND显著相关。坚持抗逆转录病毒治疗的AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044；接受初等教育的AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01；接受中等教育的AOR: 0.1(95%CI: 0.03, 0.2), p<0.001，与未接受正规教育的患者相比，认知表现良好。艾滋病毒相关的神经认知障碍在艾滋病毒感染者中很常见，特别是ANI和MND，在艾滋病毒感染的坦桑尼亚人中很常见。社会人口学和临床变量都会影响这一人群的神经认知功能。如果有有效的治疗方法，可以对轻度神经认知障碍进行筛查。
HIV-associated neurocognitive disorders (HAND) continue to manifest despite advancements and improved antiretroviral therapy coverage. Neurocognitive impairment is a significant predictor of poor prognosis related to poor antiretroviral therapy adherence and retention in HIV care. This cross-sectional study examined 397 participants attending cared for and treatment at Dodoma Regional Referral Hospital (DRRH) and selected by systematic sampling. The combination of Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and The Lawton Instrumental Activity of Daily Living (IADL) were used to assess HIV-associated neurocognitive disorders. Factors associated with HAND were determined using univariate and multivariable logistic regression. Of 397 participants, 234(59.1%) met the criteria for HAND with 231(58.2%) comprising asymptomatic neurocognitive disorder (ANI) or mild neurocognitive disorders (MND), and 3 (0.76%) HIV- associated dementia (HAD). Participants with HAND had significantly poorer performance in each cognitive domain on both MoCA and IHDS. Under multivariable regression, age of 55 years or above with Adjusted Odds Ratio (AOR): 3.5 (95%CI: 1.1, 11.6), p = 0.041 and female gender (AOR): 2.7 (95%CI: 1, 6, 4.5), p<0.001 were significantly associated with HAND. Adherence to antiretroviral therapy AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044, and attaining primary education AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01 or secondary education AOR: 0.1(95%CI: 0.03, 0.2), p<0.001 compared to having no formal education showed good cognitive performance. HIV-associated neurocognitive disorders are common in HIV, especially ANI and MND, are common in HIV infected Tanzanians. Both socio-demographic and clinical variables influence neurocognitive functioning in this population. Screening for mild neurocognitive disorders may be indicated if effective treatment becomes available.
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