Combination antiretroviral therapy (ART) improves HIV-associated neurocognitive disorder (HAND) stage in the United States where subtype B predominates, but the effect of ART and subtype on HAND stage in individuals in Uganda with subtypes D and A is largely unknown.
A community-based cohort of participants residing in Rakai, Uganda.
Three hundred ninety-nine initially ART-naive HIV-seropositive (HIV+) individuals were followed up over 2 years. Neurological and neuropsychological tests and functional assessments were used to determine HAND stage. Frequency and predictors of HAND and HIV-associated dementia (HAD) were assessed at baseline and at follow-up after ART initiation in 312 HIV+ individuals. HIV subtype was determined from gag and env sequences.
At 2-year follow-up, HAD frequency among HIV+ individuals on ART (n = 312) decreased from 13% to 5% (P < 0.001), but the overall frequency of HAND remained unchanged (56%–51%). Subtype D was associated with higher rates of impaired cognition (global deficit score ≥ 0.5) compared with HIV+ individuals with subtype A (55% vs. 24%) (P = 0.008). Factors associated with HAD at baseline were older age, depression, and plasma HIV viral load >100,000 copies/mL. At follow-up, age and depression remained significantly associated with HAD.
HIV+ individuals on ART in rural Uganda had a significant decrease in the frequency of HAD, but HAND persists after 2 years on ART. The current guideline of immediate ART initiation after HIV diagnosis is likely to greatly reduce HAD in sub-Saharan Africa. Further studies of the effect of HIV subtype and neurocognitive performance are warranted.
aDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD;
bRakai Health Sciences Program, Kalisizo, Uganda;
cDepartment of Psychiatry, Makerere University, Kampala, Uganda;
dDepartment of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, NC; and
eDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Correspondence to: Ned Sacktor, MD, Neurology, Johns Hopkins Bayview Medical Center, 301 Building, Suite 2100, 4940 Eastern Avenue, Baltimore, MD 21224 (e-mail: email@example.com).
Supported by the National Institutes of Health (NIH) (RO1 MH099733; P30 MH075673; R25 MH080661-08; R25 NS065729-0552; P30 AI094189-01A1) and the Johns Hopkins Center for Global Health.
Presented at the 2018 Conference on Retroviruses and Opportunistic Infections; March 5, 2008; Boston, MA.
The authors report no conflicts of interest.
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Received July 06, 2018
Accepted November 11, 2018