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Neurocognitive Impairment Risk Among Individuals With Multiple Drug–Resistant Tuberculosis and Human Immunodeficiency Virus Coinfection

Implications for Systematic Linkage to and Retention of Care in Tuberculosis/Human Immunodeficiency Virus Treatment

Tomita, Andrew, PhD*†; Ramlall, Suvira, PhD; Naidu, Thirusha, PhD§; Mthembu, Sbusisiwe Sandra, MA; Padayatchi, Nesri, PhD; Burns, Jonathan K., PhD‡#

The Journal of Nervous and Mental Disease: April 2019 - Volume 207 - Issue 4 - p 307–310
doi: 10.1097/NMD.0000000000000962
Brief Reports

Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug–resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was investigated in 200 microbiologically confirmed inpatients with MDR-TB at a TB-specialist hospital in KwaZulu-Natal Province, South Africa. Within this population, the prevalence of HIV coinfection, major depressive episode, and substance use disorder was 89.50%, 10.50%, and 7.00%, respectively. After excluding individuals with major depressive episode/substance use disorder and monoinfection (i.e., MDR-TB without HIV), the prevalence of HAND risk was 43.5%. Older and low-income individuals had significantly greater odds of HAND risk, whereas those with family members/relatives who work(ed) in the health services had lower odds. The role of timely linkage to and retention of care in TB/HIV treatment to offset cognitive decline in MDR-TB/HIV coinfected individuals needs to be investigated further.

*KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences,

Centre for Rural Health, School of Nursing and Public Health,

Department of Psychiatry, and

§Department of Behavioural Medicine, University of KwaZulu-Natal, Durban;

KwaZulu-Natal Department of Health, Wentworth Hospital, Durban;

Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; and

#Institute of Health Research, University of Exeter, Exeter, UK.

Send reprint requests to Andrew Tomita, PhD, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Private Bag X7, Congella 4013, South Africa. E-mail:

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