Neurocognitive functioning in women with HIV: a comparative study in a low/middle-income country.

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 with HIV (WWH) was compared to women without HIV (WWOH) in South Africa between 2018 and 2019.

Design: A cross-sectional study.

Methods: WWH from the Pro mise O ngoing T reatment E valuation (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 WWH. More WWH had NCI (46 vs. 36%, P  = 0.06) and mild to severe deficits in verbal learning and memory (51 vs. 30%, P  < 0.001), motor speed (32 vs. 19%, P  = 0.002), language (55 vs. 44%, P  = 0.021), and information processing (40 vs. 25%, P  = 0.001). The risk of NCI was higher in women aged at least 35 years [relative risk (RR): 1.46, 95% confidence interval (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: WWH 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.