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      Prevalence of Neurocognitive Impairment and Associated Factors Among People Living with HIV on Highly Active Antiretroviral Treatment, Ethiopia

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          Abstract

          Background

          The burden of HIV is mainly found in Sub Saharan Africa. The HIV-associated neurocognitive impairment is found to be higher and it can exist at all stages of HIV. The HIV-associated neurocognitive impairment has a significant impact on a patient’s daily living and highly active antiretroviral treatment (HAART) adherence. Therefore, this study aimed to determine the prevalence and associated factors of HIV-associated neurocognitive impairment among adult people on HIV treatment.

          Methods

          A total of 423 people living with HIV/AIDS were planned to include in the study. A systematic random sampling technique was used to get the study participants. Binary logistic regression analysis was used to identify associated factors of HIV-associated neurocognitive impairment. Factors with a p-value of ≤ 0.2 on bivariate analyses were recruited for multivariate logistic regression analyses, and 95% CI at p-value < 0.05 was considered as statistically significant. Variance inflation factors for continuous variables and Spearman rank correlation for categorical variables were performed. There was no multicollinearity between suspected predictor variables. Model fitness was checked using Hosmer and Lemeshow Test, and its p-value was 0.45.

          Result

          A total of 422 individuals on HAART were included which gave a response rate of 99.8%. The prevalence of HIV-associated neurocognitive impairment was 41% (95% CI=36.3, 45.6). Older individuals, low monthly income, having comorbid depression and anxiety, have no communication about safe sexual intercourse, higher duration of HIV illness, and having poor social support were statistically significant associated factors of HIV neurocognitive impairment.

          Conclusion

          Two among five HIV patients on HAART treatment experienced HIV-associated neurocognitive impairment. It will be better if health professionals working at the HIV/TB clinic screen and consult HIV patients for psychiatric evaluation and treatment. Due attention should be given to HIV patients with associated factors.

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          Most cited references24

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            An ultra-brief screening scale for anxiety and depression: the PHQ-4.

            The most common mental disorders in both outpatient settings and the general population are depression and anxiety, which frequently coexist. Both of these disorders are associated with considerable disability. When the disorders co-occur, the disability is even greater. Authors sought to test an ultra-brief screening tool for both. Validated two-item ultra-brief screeners for depression and anxiety were combined to constitute the Patient Health Questionnaire for Depression and Anxiety (the PHQ-4). Data were analyzed from 2,149 patients drawn from 15 primary-care clinics in the United States. Factor analysis confirmed two discrete factors (Depression and Anxiety) that explained 84% of the total variance. Increasing PHQ-4 scores were strongly associated with functional impairment, disability days, and healthcare use. Anxiety had a substantial effect on functional status that was independent of depression. The PHQ-4 is a valid ultra-brief tool for detecting both anxiety and depressive disorders.
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              Updated research nosology for HIV-associated neurocognitive disorders.

              In 1991, the AIDS Task Force of the American Academy of Neurology published nomenclature and research case definitions to guide the diagnosis of neurologic manifestations of HIV-1 infection. Now, 16 years later, the National Institute of Mental Health and the National Institute of Neurological Diseases and Stroke have charged a working group to critically review the adequacy and utility of these definitional criteria and to identify aspects that require updating. This report represents a majority view, and unanimity was not reached on all points. It reviews our collective experience with HIV-associated neurocognitive disorders (HAND), particularly since the advent of highly active antiretroviral treatment, and their definitional criteria; discusses the impact of comorbidities; and suggests inclusion of the term asymptomatic neurocognitive impairment to categorize individuals with subclinical impairment. An algorithm is proposed to assist in standardized diagnostic classification of HAND.
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                Author and article information

                Journal
                HIV AIDS (Auckl)
                HIV AIDS (Auckl)
                hiv
                hiv
                HIV/AIDS (Auckland, N.Z.)
                Dove
                1179-1373
                16 April 2021
                2021
                : 13
                : 425-433
                Affiliations
                [1 ]Debre Berhan University, College of Health Science, Department of Psychiatry , Debre Berhan, Ethiopia
                [2 ]Debre Berhan University, College of Health Science, Department of Nursing , Debre Berhan, Ethiopia
                Author notes
                Correspondence: Abate Dargie Wubetu Debre Berhan University, College of Health Science, Department of Psychiatry Tel +251 910916569 Email abatedargie2001@gmail.com
                Author information
                http://orcid.org/0000-0002-8312-5719
                http://orcid.org/0000-0002-6886-5145
                Article
                298141
                10.2147/HIV.S298141
                8057951
                33889028
                e916e692-6c3a-42d6-9581-e948a322d209
                © 2021 Wubetu et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 19 December 2020
                : 31 March 2021
                Page count
                Figures: 0, Tables: 4, References: 25, Pages: 9
                Funding
                Funded by: Debre Berhan University;
                This study was funded by Debre Berhan University. The title is the subtheme of the mega-project title as the health-related impact of HIV/AIDS in North Shoa Zone. The funding institution had a role in data collection, analysis, and write-up.
                Categories
                Original Research

                Infectious disease & Microbiology
                hiv,haart,cognition,neurocognitive deficit,ethiopia
                Infectious disease & Microbiology
                hiv, haart, cognition, neurocognitive deficit, ethiopia

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