Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
J Acquir Immune Defic Syndr. 2020 Feb 1;83(2):157-164. doi: 10.1097/QAI.0000000000002242.
Medication adherence is a critical issue in achieving viral suppression targets, particularly in resource-limited countries. As HIV-related cognitive impairment (CI) impacts adherence, we examined frequency and predictors of CI in the African Cohort Study.
Cross-sectional examination of enrollment data from President's Emergency Plan for AIDS Relief supported clinic sites.
In a 30-minute cognitive assessment, CI was defined as -1SD on 2 tests or -2SD on one, as compared with 429 controls. We performed univariable and multivariable logistic and linear models examining clinical and demographic factors associated with CI and global neuropsychological performance (NP-6).
Two thousand four hundred seventy-two HIV+ participants from Kenya (n = 1503), Tanzania (n = 469), and Uganda (n = 500). The mean (SD) age was 39.7 (10.7) years, and 1452 (59%) were women. The majority reported completing or partially completing primary school (n = 1584, 64%). Mean (SD) current and nadir CD4 count were 463 (249) and 204 (221) cells/mm, respectively; 1689 (68%) were on combination antiretroviral therapy. Nine hundred thirty-nine (38%) HIV+ versus 113 (26%) HIV- individuals showed CI: (P < 0.001). We found significant effects of literacy [odds ratio (OR): 0.3; 95% CI: 0.2 to 0.4; P < 0.001] and World Health Organization stage 4 (OR: 1.5; 95% CI: 1.0 to 2.q; P = 0.046) on CI. Tanzanians (OR: 3.2; 95% CI: 2.4 to 4.3; P < 0.001) and Kenyans (OR: 2.0; 95% CI: 1.6 to 2.6; P < 0.001) had higher risk of CI compared with Ugandans. Results were relatively unchanged in predictive models of NP-6, with the only difference being an additional significant effect of current CD4 cell count (coeff: 0.0; 95% CI: 0.0 to 0.0; P = 0.005).
Literacy, country, World Health Organization stage, and current CD4 cell count were associated with increased risk of cognitive dysfunction. Our findings help optimize care practices in Africa, illustrating the importance of strategies for early and effective viral-immunological control.
药物依从性是实现病毒抑制目标的关键问题，特别是在资源有限的国家。由于与 HIV 相关的认知障碍（CI）会影响依从性，因此我们检查了非洲队列研究中 CI 的频率和预测因素。
总统艾滋病紧急救援计划支持的诊所网站的注册数据的横断面检查。
在 30 分钟的认知评估中，CI 定义为与 429 名对照相比，两项测试的-1SD 或一项测试的-2SD。我们进行了单变量和多变量逻辑和线性模型检查，以研究与 CI 和全球神经心理表现（NP-6）相关的临床和人口统计学因素。
来自肯尼亚（n=1503）、坦桑尼亚（n=469）和乌干达（n=500）的 2472 名 HIV+参与者。平均（SD）年龄为 39.7（10.7）岁，1452 名（59%）为女性。大多数人报告完成或部分完成小学学业（n=1584，64%）。当前和最低 CD4 计数的平均值（SD）分别为 463（249）和 204（221）细胞/mm；1689 名（68%）正在接受联合抗逆转录病毒治疗。939 名 HIV+患者（38%）与 113 名 HIV-患者（26%）表现出 CI：（P<0.001）。我们发现文化程度（比值比[OR]：0.3；95%置信区间[CI]：0.2 至 0.4；P<0.001）和世卫组织第 4 阶段（OR：1.5；95% CI：1.0 至 2.q；P=0.046）对 CI 有显著影响。坦桑尼亚人（OR：3.2；95% CI：2.4 至 4.3；P<0.001）和肯尼亚人（OR：2.0；95% CI：1.6 至 2.6；P<0.001）与乌干达人相比，CI 的风险更高。NP-6 的预测模型中的结果相对不变，唯一的区别是当前 CD4 细胞计数的额外显著影响（系数：0.0；95% CI：0.0 至 0.0；P=0.005）。
文化程度、国家、世卫组织阶段和当前 CD4 细胞计数与认知功能障碍风险增加相关。我们的研究结果有助于优化非洲的护理实践，说明早期和有效病毒免疫控制策略的重要性。
