scholarly journals Association between HIV infection and neurocognitive disorders: a review

2021 ◽  
Author(s):  
Rafael Felipe Silva Rodrigues ◽  
Ana Luiza Soares Henriques de Almeida ◽  
Amanda Mansur Rosa ◽  
Suelen Darlane Vieira ◽  
Luciana Maria Campos e Silva ◽  
...  
Keyword(s):  
Viral Load ◽  
Life Expectancy ◽  
Highly Active Antiretroviral Therapy ◽  
Brain Aging ◽  
Neurocognitive Disorders ◽  
Brain Inflammation ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
The Impact

Background: HIV-associated neurocognitive disorders (HAND) are characterized by impairment in at least two cognitive domains with a prevalence of up to 50% in people living with HIV (PLHIV). HAND is subdivided into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD). Objectives: Demonstrate the impact of HAND and possible pathogenic mechanisms by relating them to the prevalence of subtypes Design and Setting: Review of the literature. Methods: Review made from PubMed with the descriptors “neurocognitive disorder”, “HIV”, “review”. Twelve articles were selected, among systematic reviews and meta-analysis published since 2017. Results: Before Highly Active Antiretroviral Therapy (HAART) HAD cases had a higher prevalence, probably due to the high viral load causing intense brain inflammation. Today the percentage of HAD has decreased, but the cases of ANI and MND continue to increase. HAART increases life expectancy and reduces viral load, but it may be related to the increase in ANI / MND associated with early brain aging and mild inflammatory processes resulting from primary infection. Conclusions: HAND is a concern for its impact on the quality of life and life expectancy of PLHIV. Therefore, neuropsychological assessment is an important tool for early diagnosis and disease management. The change in prevalence of different HAND subtypes raises doubts about the pathogenesis of these conditions and further studies are needed to elucidate this issue and develop therapeutic solutions.

HIV-Associated Neurocognitive Disorders

2019 ◽  
pp. 27-60
Author(s):  
Jennifer E.  Iudicello ◽  
Erin E. Morgan ◽  
Mariam A. Hussain ◽  
Caitlin Wei-Ming Watson ◽  
Robert K. Heaton
Keyword(s):  
Differential Diagnosis ◽  
Neurocognitive Impairment ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Diagnostic Systems ◽  
Neurocognitive Performance ◽  
Everyday Functioning ◽  
Asymptomatic Neurocognitive Impairment ◽  
Age Related

Human immunodeficiency virus enters the central nervous system (CNS) early after systemic infection, and may cause neural injury and associated neurocognitive impairment through multiple direct and indirect mechanisms. An international conference of multidisciplinary neuroAIDS experts convened in 2005 to propose operationalized research criteria for HIV-related cognitive and everyday functioning impairments. The resulting classification system, known as the Frascati criteria, defined three types of HIV-associated neurocognitive disorder (HAND): asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia (HAD). Consideration of comorbid conditions that can influence neurocognitive performance, such as developmental disabilities, non-HIV forms of CNS compromise (neurological and systemic), severe psychiatric conditions, and substance use disorders, is essential to differential diagnosis. Since the introduction of combination antiretroviral therapy (ART), rates of severe HAND (i.e., HAD) have greatly declined, although the milder forms of HAND remain quite prevalent, even in virally suppressed people living with HIV (PLWH). Beyond ART, clinical management of HAND includes behavioral interventions focused on neurocognitive and functional improvements. This chapter covers a range of HAND-related topics, such as the neuropathological mechanisms of HIV-related CNS injury, assessment and diagnostic systems for neurocognitive and everyday functioning impairment in HIV, treatment and protective factors, aging with HIV, HAND in international settings, and ongoing challenges and controversies in the field. Future needs for progress with HAND include advances in early detection of mild cognitive deficits and associated functional impairment in PLWH; biomarkers that may be sensitive to its underlying pathogenesis; and differential diagnosis of HAND versus age-related, non-HIV-associated disorders.

scholarly journals Late Onset of Antiretroviral Therapy in Adults Living with HIV in an Urban Area in Brazil: Prevalence and Risk Factors

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Priscila Ribeiro Guimarães Pacheco ◽  
Ana Laura Sene Amâncio Zara ◽  
Luiz Carlos Silva e Souza ◽  
Marília Dalva Turchi
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Perceived Risk ◽  
Opportunistic Infections ◽  
Late Onset ◽  
Baseline Viral Load ◽  
People Living With Hiv ◽  
Late Initiation ◽  
Living With Hiv

Introduction. Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART) leads to improved therapeutic response and reduced HIV transmission. However, a significant number of people living with HIV (PLHIV) still start treatment late. Objective. This study aimed to analyze characteristics and factors associated with late initiation of ART among HIV-infected treatment-naïve patients. Methods. This cross-sectional study included PLHIV older than 17 years who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System (SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defined as CD4+ cell count < 200 cells/mm3 or presence of AIDS-defining illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS®, version 21. The significance level was set at p<0.05. Results. 1,141 individuals were included, with a median age of 41 years, and 69.1% were male. The prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). The more common opportunistic infections at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. After logistic regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion. These results revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially vulnerable or have lower self-perceived risk.

scholarly journals Differences among U.S. States in Estimating the Number of People Living with HIV/AIDS: Impact on Allocation of Federal Ryan White Funding

2007 ◽  
Vol 122 (5) ◽  
pp. 644-656 ◽  
Author(s):  
Denis Nash ◽  
Evie Andreopoulos ◽  
Deborah Horowitz ◽  
Nancy Sohler ◽  
David Vlahov
Keyword(s):  
Viral Load ◽  
Laboratory Data ◽  
People Living With Hiv ◽  
Surveillance Systems ◽  
Detectable Viral Load ◽  
Hiv Positive Women ◽  
Ryan White ◽  
Immunodeficiency Syndrome ◽  
The Impact ◽  
Hiv Aids

Objective. We assessed the impact of differing laboratory reporting scenarios on the completeness of estimates of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) in the U.S., which are used to guide allocation of federal Ryan White funds. Methods. We conducted a four-year simulation study using clinical and laboratory data on 1,337 HIV-positive women, including 477 (36%) who did not have AIDS at baseline. We estimated the completeness of HIV (non-AIDS) case ascertainment for three laboratory reporting scenarios: CD4<200 cells/μL and detectable viral load (Scenario A); CD4<500 cells/μL and no viral load reporting (Scenario B); and CD4<500 cells/μL and detectable viral load (Scenario C). Results. Each scenario resulted in an increasing proportion of HIV (non-AIDS) cases being ascertained over time, with Scenario C yielding the highest by Year 4 (Year 1: 69.0%, Year 4: 88.1%), followed by Scenario A (Year 1: 63.3%, Year 4: 84.5%), and Scenario B (Year 1: 43.0%, Year 4: 67.7%). Overall completeness of PLWHA ascertainment after four years was highest for Scenario C (95.8%), followed by Scenario A (94.5%), and Scenario B (88.5%). Conclusions. Differences in laboratory reporting regulations lead to substantial variations in the completeness of PLWHA estimates, and may penalize jurisdictions that are most successful at treating HIV/AIDS patients or those with weak or incomplete HIV/AIDS surveillance systems.

Global prevalence and burden of HIV-associated neurocognitive disorder

Neurology ◽  
2020 ◽  
Vol 95 (19) ◽  
pp. e2610-e2621 ◽  
Author(s):  
Yunhe Wang ◽  
Moxuan Liu ◽  
Qingdong Lu ◽  
Michael Farrell ◽  
Julia M. Lappin ◽  
...  
Keyword(s):  
Data Extraction ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
Cd4 Cell Count ◽  
Hiv Associated Neurocognitive Disorder ◽  
Sub Saharan ◽  
High Level

ObjectiveTo characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV.MethodsWe searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide.ResultsOf 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7–45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3–26.8), 13.3% (10.6–16.3), and 5.0% (3.5–6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5–49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7–41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300–17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000–13,568,000).ConclusionsOur findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.

scholarly journals Physicians’ patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023957
Author(s):  
Beverly Allan ◽  
Kalysha Closson ◽  
Alexandra B Collins ◽  
Mia Kibel ◽  
Shenyi Pan ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Base Composition ◽  
Cox Model ◽  
Cox Proportional Hazards ◽  
Future Research ◽  
People Living With Hiv ◽  
All Cause Mortality ◽  
Living With Hiv ◽  
The Impact

ObjectivesTo assess the impact of physicians’ patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada.DesignObservational cohort study from 1 January 2000 to 31 December 2013.SettingBC Centre for Excellence in HIV/AIDS’ (BC-CfE) Drug Treatment Program, where HAART is available at no cost.ParticipantsPLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study.Outcome measuresAll-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency.Statistical analysisWe examined the relationships between patient characteristics, physicians’ patient base composition, the location of the practice, and physicians’ experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models.ResultsA total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34–49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23–170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004–2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000–2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians’ patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03–1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality.ConclusionsOur findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians’ patient bases and survival.

scholarly journals Antiretroviral therapy does not affect response to chronic hepatitis C therapy in HIV-coinfected patients

2016 ◽  
Vol 10 (07) ◽  
pp. 762-769
Author(s):  
Luciana Brosina De Leon ◽  
Cristiane Valle Tovo ◽  
Dimas Alexandre Kliemann ◽  
Angelo Alves De Mattos ◽  
Alberi Adolfo Feltrin ◽  
...  
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Demographic Data ◽  
Transcriptase Inhibitor ◽  
Intention To Treat ◽  
Highly Active ◽  
Direct Acting ◽  
The Impact

Introduction: Many patients coinfected with the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are using highly active antiretroviral therapy (HAART) and HCV therapy with peginterferon (PEG-IFN) and ribavirina (RBV) because the use of direct-acting antivirals is not a reality in some countries. To know the impact of such medications in the sustained virological response (SVR) during HCV treatment is of great importance. Methodology: This was a retrospective cohort study of 215 coinfected HIV/HCV patients. The patients were treated with PEG-IFN and RBV between 2007 and 2013 and analyzed by intention to treat. Treatment-experienced patients to HCV and carriers of hepatitis B were excluded. Demographic data (gender, age), mode of infection, HCV genotype, HCV viral load, hepatic fibrosis, HIV status, and type of PEG were evaluated. One hundred eighty-eight (87.4%) patients were using HAART. Results: SVR was achieved in 55 (29.3%) patients using HAART and in 9 (33.3%) patients not using HAART (p = 0.86). There was no difference in SVR between different HAART medications and regimens using two reverse transcriptase inhibitor nucleosides (NRTIs) or the use of protease inhibitors and non-NRTIs (27.1% versus 31.5%; p = 0.61). The predictive factors for obtaining SVR were low HCV viral load, non-1 genotype, and the use of peginterferon-α2a. Conclusions: The use of HAART does not influence the SVR of HCV under PEG-IFN and RBV therapy in HIV/HCV coinfected patients.

scholarly journals HIV patient access to healthcare services in post-austerity era in Greece

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
George Tsiakalakis ◽  
Christina Golna ◽  
Nikos Dedes ◽  
George Papageorgiou ◽  
Kostas Athanasakis ◽  
...  
Keyword(s):  
Viral Load ◽  
Economic Crisis ◽  
Access To Health Care ◽  
Health Care Services ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Patient Access ◽  
Content Type ◽  
The Past ◽  
The Impact

Purpose The ten-year economic crisis and the ensuing fiscal adjustment that Greece experienced between 2009 and 2018 has had a major impact on patient access to health-care services and resulted in an increase in unmet population health needs. The present study aims to assess the impact of economic crisis and ensuing austerity on HIV patient access to health-care services. Design/methodology/approach A cross-sectional study was carried out between February and April 2019 to assess barriers in access to HIV care faced by people living with HIV. A total of 329 HIV positive individuals participated in the study. An online, self-reporting questionnaire was developed and adapted to the specific clinical and societal characteristics of HIV. Findings A total of 94.2% of respondents were male and 67.80% lived in Athens. Most of them were diagnosed with HIV-1 10 years ago. Out of the total respondents, 37.40% reported obstacles in accessing HIV care over the past year. A total of 24.30% reported they were not tested for viral load in the past six months and received a result. Individuals, who self-evaluate their financial status as very bad or bad, were more likely to be unaware of their viral load (55.60%) than those with better financial status (33.5%) (P < 0.01). Only 33.3% of uninsured participants were aware of their viral load, and this figure rose to 63.30% (P <0.01) amongst insured participants. Originality/value The ten-year economic crisis that Greece experienced in the period 2009–2018 had significant effects on the quality of services of the National Health System. This study attempts to fill the research gap regarding the impact of one of the severest economic crises during the past century with complex social extensions, in one of the most vulnerable patient groups. In this context, the study assesses barriers to access to optimal care of people living with HIV in Greece after a decade of austerity and the variables that impact on such access.

HIV-Associated Neurocognitive Disorders

2017 ◽  
Author(s):  
Joshua Alexander ◽  
David J Croteau ◽  
Ronald J Ellis
Keyword(s):  
Cognitive Impairment ◽  
Antiretroviral Therapy ◽  
Neurocognitive Disorders ◽  
Virologic Suppression ◽  
Neurocognitive Disorder ◽  
Asymptomatic Neurocognitive Impairment ◽  
Antiretroviral Adherence ◽  
Combined Antiretroviral Therapy ◽  
Neurocognitive Decline ◽  
Hiv Associated Neurocognitive Disorders

Three subclassifications of HIV Associated Neurocognitive Disorders (HAND) can be delineated: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HIV-associated dementia (HAD). HAND occurs in about half of patients infected with HIV. All forms, including ANI and MND, are associated with unemployment and reduced antiretroviral adherence, which can lead to loss of virologic suppression, further neurocognitive decline, and systemic illness. Fortunately, combined antiretroviral therapy can stabilize and even reverse cognitive impairment.

scholarly journals Prevalence and Correlates of Neurocognitive Disorders among HIV Patients on Antiretroviral Therapy at a Kenyan Hospital

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
A. G. Mugendi ◽  
M. N. Kubo ◽  
D. G. Nyamu ◽  
L. M. Mwaniki ◽  
S. K. Wahome ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Care ◽  
Neurocognitive Impairment ◽  
Neurocognitive Disorders ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
Living With Hiv

Background. HIV-associated neurocognitive disorders (HAND) represent a spectrum of cognitive abnormalities affecting attention, concentration, learning, memory, executive function, psychomotor speed, and/or dexterity. Our objectives in this analysis are to determine the prevalence of HAND and the covariates in a Kenyan population. Methods. We conducted a cross-sectional study in a convenient sample of people living with HIV on antiretroviral therapy (ART) attending routine care visits at the Kenyatta National Hospital HIV clinic between July and August 2015. Baseline demographics were obtained using interviewer-administered questionnaires; clinical data were abstracted from patient records. Trained research clinicians determined the neurocognitive status by administration of the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) scale, and the Lawton Instrumental Activities of Daily Living (IADL) scale. Cognitive impairment was defined as a score of ≤26 on the MOCA and ≤10 on the IHDS. Descriptive analysis and logistic regression to determine predictors of screening positive for HAND were done with the significance value set at <0.05. Results. We enrolled 345 participants (202 men; 143 women). The mean age of the study population was 42 years (±standard deviation (SD) 9.5). Mean duration since HIV diagnosis and mean duration on ART were 6.3 (±SD 3.7) and 5.6 years (±SD 3.4), respectively. Median CD4 count at interview was 446 cells/mm3 (interquartile range (IQR) 278–596). Eighty-eight percent of participants screened positive for HAND, of whom 87% had asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorders (MND) grouped together while 1% had HIV-associated dementia (HAD). Patients on AZT/3TC/EFV were 3.7 times more likely to have HAND (OR = 3.7, p=0.03) compared to other HAART regimens. In the adjusted analysis, women were more likely to suffer any form of HAND than men (aOR = 2.17, 95% CI: 1.02, 4.71; p=0.045), whereas more years in school and a higher CD4 count (aOR = 0.58, 95% CI: 0.38, 0.88; p=0.012), (aOR = 0.998, 95% CI 0.997, 0.999; p=0.013) conferred a lowered risk. Conclusion. Asymptomatic and mild neurocognitive impairment is prevalent among people living with HIV on treatment. Clinical care for HIV-positive patients should involve regular screening for neurocognitive disorders while prioritizing women and those with low education and/or low CD4 counts.

scholarly journals Prevalence and 1-year incidence of HIV-associated neurocognitive disorder (HAND) in adults aged ≥50 years attending standard HIV clinical care in Kilimanjaro, Tanzania

2021 ◽  
pp. 1-12
Author(s):  
Aidan Flatt ◽  
Tom Gentry ◽  
Johanna Kellett-Wright ◽  
Patrick Eaton ◽  
Marcella Joseph ◽  
...  
Keyword(s):  
Clinical Care ◽  
Self Report ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Low Literacy ◽  
Asymptomatic Neurocognitive Impairment ◽  
Incidence Studies ◽  
Clinical Records

Abstract Objectives: HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities. Design: Longitudinal study Participants: A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017. Measurements: HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records. Results: In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed. Conclusions: HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.

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