Profile of HIV/AIDS Neurocognitive Impairment among HIV Positive Patients in North Central Nigeria.

BACKGROUND: Human Immunodeficiency Virus (HIV) dementia is an important complication in persons with HIV/AIDS, manifesting as neurocognitive and functional impairments which are detectable on neuropsychological testing.

OBJECTIVE: To determine the profile of HIV/AIDS neurocognitive impairment and associated risk factors among adults with HIV infection in our center and determine its associative factors.

METHODS: A total of 87 HIV-seropositive patients, aged between 18- 59 years were studied. Eighty seven (87) age, sex and education-matched HIV-seronegative individuals were recruited as controls. Clinical assessments were done using standardized questionnaires developed by the AIDS Clinical Trial Group (ACTG A5199). The study participants were screened for HIV associated dementia using the International HIV dementia scale (IHDS) and a 5-test neuropsychological battery. The scores of the neuropsychological parameters of the control subjects provided the normative data. The scores of the HIV-positive participants were compared against normative data. Multivariate logistic regression was carried out to determine significant predictors to HIV-associated neurocognitive impairment.

RESULTS: The frequency of neurocognitive impairment from this study was 37.9%. Nineteen (2I.8%) patients had asymptomatic neurocognitive impairment (ANI), ten (11.5%) had mild neurocognitive disorder (MND) and four (4.6%) had HIV- associated dementia (HAD). There was a statistically significant difference in the test scores of all the cognitive domains between the persons living with HIV/AIDS and those without HIV infection, being higher in the HIV-subjects. Increased viral load and HIV positive patients not being on HAART were significantly associated with HIV-associated neurocognitive impairment (P<0.05).

CONCLUSION: The frequency of neurocognitive impairment in HIV patients was quite high. Increased viral load and lack of treatment were associated factors, suggesting a need for early initiation of HAART. Neuropsychological testing will help identify the patients who need additional support in activities of daily living.