HIV-Associated neurocognitive disorders at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Abstract

Background: Human Immunodeficiency Virus (HIV) infection causes a myriad of neurological complications including cognitive deficits referred to as HIV-Associated Neurocognitive Disorders (HAND). With the introduction of combination antiretroviral therapy, there has been an epidemiological shift in cognitive disorders with a decline in the more severe HIV-Associated Dementia (HAD) to an increase in the less severe HAND: Asymptomatic Neurocognitive Impairment (ANI) and HIVassociated Mild Neurocognitive disorder (MND). Central Nervous System (CNS) involvement in HIV interferes with cognitively demanding activities of daily living and hence a worse quality of life. Tools have been developed to help assess the degree of neurocognitive dysfunction; however, early diagnosis is delayed until symptoms are overt. Objective: To determine the prevalence and the factors associated with HIVAssociated Neurocognitive Disorders (HAND) at Moi Teaching and Referral Hospital (MTRH) at Eldoret, Kenya. Methods: A cross sectional analytical study of HIV infected patients on antiretroviral therapy attending HIV clinic. A systematic random sampling was done to select 360 patients calculated using the fisher’s exact formula. An interviewer administered structured questionnaire was used to collect socio-demographic data and the CD4 count and viral load collected from the Academic Model Providing Access to Healthcare (AMPATH) database. Pearson’s Chi Square test was used to compare proportions and independent sample t- test was used to compare continuous variables between the patients diagnosed with HAND and those without HAND. Logistic regression model was used to assess the factors associated with HAND. Results: The mean age of the study participants was 40.2 years with a standard deviation of 11.5. The overall prevalence of HAND was found in 292 patients (81.1%). Mild HAND (ANI and MND) was found in 283 patients (78.6%). Severe HAND (HAD) was in 9 patients (2.5%). The factors associated with HAND were older age OR: 1.06 (95% CI: 1.03, 1.10), male gender OR: 0.48 (95% CI: 0.24, 0.97), Advanced WHO clinical staging OR: 2.45 (95% CI: 1.20, 5.01) and a higher level of education; secondary/tertiary OR: 0.16 (95% CI: 0.07, 0.38); 0.11 (95% CI: 0.04, 0.35). Conclusion: The prevalence of HAND in this population was found to be (81.1%) which is high. HAND was more frequently associated with patients of older age and advanced WHO clinical staging. Recommendation: There is need for regular cognitive screening for early