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Prevalence of HIV-1 Infection in an elderly rural population and associations with neurocognitive impairment

Joska, John A.a; Dreyer, Anna J.a; Nightingale, Sama; Combrinck, Marc I.b; De Jager, Celeste A.c

doi: 10.1097/QAD.0000000000002257

Objective: We explored the prevalence of HIV infection in older rural South Africans and its associations, as well as the point prevalence of dementia and its associations with HIV and aging.

Design: We utilized a cross-sectional analytic design.

Methods: Using the brief Community Screening Instrument for Dementia together with a rapid HIV test, we conducted a home-based screening survey among 1150 older South Africans. We explored the prevalence of HIV and dementia, and their associations using descriptive statistics and logistic regression analysis.

Results: The HIV prevalence was 4.78%. Overall, participants were on average 71.3 years old, with nearly 70% having no primary school education. HIV+ participants were significantly younger, more likely to be single and had lower BMI. The overall dementia prevalence was 11.04%. HIV+ participants had higher rates of dementia compared with HIV− participants (18.18 vs. 10.68%) but the difference was NS. In adjusted analysis, screened dementia was associated with older age, the presence of self-reported depression and HIV+ status. Participants were also more likely to self-report cognitive impairment if they were older, depressed and had objective evidence of dementia.

Conclusion: Infection with HIV in rural older South Africans is a prevalent problem, and together with older age, is a significant contributor to cognitive impairment. It is possible that HIV infection contributes to dementia on the basis of an acceleration of degeneration – because our HIV-infected participants were younger – AND an accentuation of aging – because of the higher rates of impairment for similar age groups.

aHIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute

bDivision of Geriatric Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa

cAgeing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK.

Correspondence to John A. Joska, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Observatory, Cape Town, South Africa. E-mail:

Received 1 February, 2019

Revised 18 April, 2019

Accepted 18 April, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.