Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Clin Neurol Neurosurg. 2021 Nov;210:107003. doi: 10.1016/j.clineuro.2021.107003. Epub 2021 Oct 23.
Widespread introduction of early combination antiretroviral therapy (cART) for People Living with HIV (PLWH) will influence the burden, profile, and trajectory of HIV-associated neurocognitive disorders (HAND) in the 21st century.
To assess the prevalence and trajectory of HAND among PLWH in a Ghanaian tertiary medical center.
We analyzed the dataset of a study involving PLWH established on cART (n = 256) and PLWH not initially on cART (n = 244). HIV-negative individuals (n = 246) served as normative controls for neurocognitive assessments. HAND was defined according to the Frascati criteria into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD) at enrollment and at month 12. Multivariate logistic regression models were fitted to identify factors associated with HAND.
Among PLWH on cART, 21.5%, 3.5% and 0.0% had ANI, MND and HAD respectively compared with 20.1%, 9.8% and 2.0% among PLWH cART naïve, p < 0.0001. Overall, 71.6%, 20.8%, 6.6% and 1.0% had no cognitive impairment, ANI, MND and HAD at baseline. Among participants who completed month 12 follow-up, 55.2% had no cognitive impairment, 43.5%, 1.2%, 0.0% had ANI, MND and HAD respectively, p < 0.0001. Adjusted odds ratio (95% CI) of six independent predictors of HAND at month 12 were no education (3.29;1.81-6.00), stage 4 disease (4.64;1.37-15.69), hypertension (2.28;1.10-4.73), nevirapine use (2.05;1.04-4.05), baseline viral load (0.66;0.56-0.77), and cigarette use (0.10; 0.03-0.42).
Most Ghanaian patients in the post-cART era with HAND had mild neurocognitive impairments. The impact of hypertension on progression of HAND warrants further evaluation in our settings.
广泛推广针对艾滋病毒感染者（PLWH）的早期联合抗逆转录病毒治疗（cART）将影响 21 世纪艾滋病毒相关神经认知障碍（HAND）的负担、特征和轨迹。
评估加纳一家三级医疗中心的 PLWH 中 HAND 的流行率和轨迹。
我们分析了一项研究的数据，该研究涉及已接受 cART 的 PLWH（n=256）和最初未接受 cART 的 PLWH（n=244）。HIV 阴性个体（n=246）作为神经认知评估的正常对照。根据 Frascati 标准，HAND 在入组时和第 12 个月定义为无症状神经认知障碍（ANI）、轻度神经认知障碍（MND）和 HIV 相关痴呆（HAD）。采用多变量逻辑回归模型确定与 HAND 相关的因素。
在接受 cART 的 PLWH 中，21.5%、3.5%和 0.0%分别患有 ANI、MND 和 HAD，而未接受 cART 的 PLWH 中分别为 20.1%、9.8%和 2.0%，p<0.0001。总体而言，71.6%、20.8%、6.6%和 1.0%在基线时无认知障碍、ANI、MND 和 HAD。在完成第 12 个月随访的参与者中，55.2%无认知障碍，43.5%、1.2%、0.0%分别为 ANI、MND 和 HAD，p<0.0001。HAND 在第 12 个月的 6 个独立预测因素的调整优势比（95%CI）为无教育（3.29；1.81-6.00）、4 期疾病（4.64；1.37-15.69）、高血压（2.28；1.10-4.73）、奈韦拉平使用（2.05；1.04-4.05）、基线病毒载量（0.66；0.56-0.77）和吸烟（0.10；0.03-0.42）。
加纳 HAND 患者在 cART 后时代，大多数患者有轻度神经认知障碍。高血压对 HAND 进展的影响值得在我们的环境中进一步评估。
