Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe.

Journal: BMC infectious diseases

Volume: 20

Issue: 1

Year of Publication: 2020

Affiliated Institutions:  Department of Psychiatry, College of Health Sciences, African Mental Health Research Initiative, University of Zimbabwe, Harare, Zimbabwe. primrose.nyamayaro@gmail.com. Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. New York State Psychiatric Institute, Columbia University, New York, NY, USA. Department of Psychiatry, College of Health Sciences, African Mental Health Research Initiative, University of Zimbabwe, Harare, Zimbabwe.

Abstract summary 

HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls.Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning.Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI.NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.

Authors & Co-authors:  Nyamayaro Primrose P Gouse Hetta H Hakim James J Robbins Reuben N RN Chibanda Dixon D

Study Outcome 

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Statistics
Citations :  Ministry of Health and Child Care (MOHCC), Zimbabwe. Zimbabwe National and Sub-national HIV Estimates Report. 2018.
Authors :  5
Identifiers
Doi : 383
SSN : 1471-2334
Study Population
Male,Female
Mesh Terms
Activities of Daily Living
Other Terms
HIV;Neurocognitive impairment;Neuropsychological assessment;Treatment-experienced
Study Design
Cross Sectional Study
Study Approach
Country of Study
Zimbabwe
Publication Country
England