Newcastle University, Newcastle upon Tyne, UK.
Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania.
Int Psychogeriatr. 2023 Jul;35(7):339-350. doi: 10.1017/S1041610221000156. Epub 2021 Mar 24.
HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
Longitudinal study.
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March-May 2016 and followed up March-May 2017.
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9-53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0-28.6 n = 16) was observed.
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
艾滋病毒相关神经认知障碍（HAND）在全球范围内，HIV 感染者（PLWH）中的老年人中较为普遍。目前，在撒哈拉以南非洲地区，针对新出现的接受联合抗逆转录病毒疗法（cART）治疗的老年 PLWH 人群，尚缺乏 HAND 患病率和发病率的研究。我们旨在通过在坦桑尼亚长期随访的接受 cART 治疗的稳定老年成年人中使用可靠的措施来估计 HAND 的患病率和发病率，并报告认知合并症。
纵向研究。
2016 年 3 月至 5 月期间，在一个艾滋病毒护理和治疗中心参加常规临床护理的，同意参加研究的，年龄≥50 岁的 HIV 阳性成年人中，系统地抽取了一个样本。2017 年 3 月至 5 月进行了随访。
根据详细的本地标准化低识字神经心理测试组合，进行共识小组 Frascati 标准评估，通过结构化神经精神病学临床评估和间接病史进行 HAND 评估。通过自我报告和临床记录评估人口统计学和病因因素。
在本队列（n = 253，72.3%为女性，中位年龄 57 岁）中，尽管 HIV 疾病得到了很好的控制（中位数 CD4 516（98-1719），95.5%接受 cART），HAND 的患病率仍为 47.0%（95%CI 40.9-53.2，n = 119）。其中，64 例（25.3%）为无症状性神经认知障碍，46 例（18.2%）为轻度神经认知障碍，9 例（3.6%）为 HIV 相关性痴呆。一年的发病率较高（37.2%，95%CI 25.9-51.8），但有一定的逆转率（17.6%，95%CI 10.0-28.6，n = 16）。
在这种情况下，HAND 在该老年 PLWH 人群中患病率很高，其人口统计学特征与高收入人群明显不同，且合并症较为常见。发病率和逆转率也似乎较高。未来的研究应集中于该环境下的病因和潜在的可逆转因素。
