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Article Abstract
Objective: In untreated HIV infection, the prevalence of HIV-associated neurocognitive disorders was high. Studies from the ART era with appropriate controls from a resource-limited setting are lacking. Neurocognitive functioning of young women living with HIV (WLWH) was compared to women without HIV (WWOH) in South Africa between 2018 and 2019.
Design: Cross-sectional study.
Methods: WLWH from thePromise Ongoing Treatment Evaluation (PROMOTE) study and WWOH completed a neuropsychological battery targeted at domains affected by HIV. Factors known to be associated with neurocognitive impairment (NCI) were assessed by generalized linear model adjusting for covariates. Clinical symptoms were evaluated using WHODAS.
Results: Of 451 women, with a median age of 35 (IQR: 31 - 39) years, 224 (49.7%) were WLWH. More WLWH had NCI (46% vs. 36%, p-value = 0.06) and mild to severe deficits in: verbal learning and memory (51% vs. 30%, p-value<0.001), motor speed (32% vs. 19%, p-value = 0.002), language (55% vs. 44%, p-value = 0.021) and information processing (40% vs. 25%, p-value = 0.001). The risk of neurocognitive impairment was higher in women ≥ 35 years (RR: 1.46, 95% CI: 1.16-1.84, p = 0.001), incomplete secondary education (RR: 1.26, 95% CI: 1.01-1.58, p = 0.04), HIV infection (RR: 1.26, 95% CI: 1.02-1.56, p = 0.03) and high alcohol use (RR: 1.42, 95% CI: 1.13-1.78, p = 0.003).
Conclusion: WLWH on long-term ART had a high prevalence of NCI. High alcohol use and incomplete secondary education were significant risk factors in all women. This study highlights the higher risk of NCI in this population despite a younger age and successful ART.
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