The Medical School, Newcastle University, Newcastle upon Tyne, UK.
Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
Int J Geriatr Psychiatry. 2020 Oct;35(10):1198-1208. doi: 10.1002/gps.5357. Epub 2020 Jul 20.
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.
尽管艾滋病相关认知障碍（HAND）较为普遍，但在撒哈拉以南非洲（SSA），其仍然是一个研究不足的导致发病的原因。我们旨在探索坦桑尼亚政府艾滋病毒诊所定期随访的 50 岁及以上人群HAND 的危险因素。
在为期 4 个月的常规 HIV 诊所预约期间，我们对年龄在 50 岁及以上的 HIV 阳性成年人进行了招募。我们通过全面的医学/神经学评估和亲属的间接病史对 HAND 进行了诊断评估。我们通过结构问卷和检查诊所记录来研究潜在的危险因素。
在该队列（n=253）中，183 名（72.3%）为女性，中位年龄为 57 岁。55 名（21.7%）患者符合有症状 HAND 的标准。如果独居（比值比[OR] = 2.566，P = 0.015）、文盲（OR 3.171，P = 0.003）或在 HIV 诊断时年龄较大（OR = 1.057，P = 0.015），参与者患有症状 HAND 的风险更高。年龄与有症状 HAND 呈单变量相关，但在多变量分析中不相关。
在这种情况下，HIV 特异性因素，如 CD4 计数最低点，与有症状 HAND 无关。在开始抗逆转录病毒治疗之前，早期中枢神经系统损伤的“遗留理论”可能在一定程度上导致老年人HAND 的多因素病因。社会隔离和文盲与有症状 HAND 相关，这表明更大的认知储备可能具有保护作用。
