Neurocognitive correlates of the use of combined Antiretroviral Therapy among HIV-infected adults attending care and treatment center at Muhimbili National Hospital, Dar es Salaam, Tanzania: An analytical crosssectional study

Abstract

Background: The discovery of the highly active antiretroviral therapy has improved the life span of people living with HIV/AIDS (PLWHA) to almost that of the general population. This, however, has been coupled with increased incidences of HIVassociated dementia, especially mild cognitive impairment. Combined antiretroviral therapy (cART) has been observed to improve neurocognitive functions but the ART regimen that is best suited for improvement of neurocognitive functions is still largely unknown. This study was aimed at determining how neurocognitive deficits in patients on cART were related to ART regimen.

Methods: This was a cross-sectional analytical study. A sample of 351 adult patients attending care and treatment center (CTC) at Muhimbili National Hospital (MNH) in Dar es salaam, Tanzania were screened for HIV-associated neurocognitive deficits (HAND) against the ART regimens the patients were using. The study that was conducted from July to August 2012 and employed a standardized tool known as International HIV Dementia Scale (IHDS). Analysis was done using SPSS version 18. Frequency distribution, Chi-square, Fisher’s exact test and multivariate regression analysis were calculated to determine the levels of risk which was set at 5% significance level (p < 0.05).

Results: Two hundred and forty of the 351 (68.4%) patients screened positive for neurocognitive deficits. Under descriptive statistics, factors such as age, years of formal education, central nervous system penetration effectiveness (CPE) score and the use of efavirenz containing regimens showed statistically significant association with HAND at p=0.03, p=0.038, p<0.001 and p=0.039, respectively, while on multivariate analysis only ART combination with CPE based on 2010 scoring system showed significant association system (p=0.02, AOR=0.449 and C.I=0.27-0.748) with HAND.

Conclusion: These findings support the hypothesis that specific ART factors such as CPE may be protective against neurocognitive deficits. The study also highlights the need to choose appropriate ART regimen with special consideration to their potential neurotoxic side effect. Individual assessment for best therapeutic response is crucial for the patients’ cognitive wellbeing.

Keywords: HIV-associated neurocognitive deficits (HAND), Antiretroviral, Central nervous system penetration, Muhimbili National Hospital, Dar es Salaam, Tanzania