Cognitive impairment among HIV-infected adults on antiretroviral therapy in Indonesia

Abstract

Introduction: Human immunodeficiency virus (HIV) infection and its related complications remain a health problem in developing countries.Cognitive impairment is a complication of HIV infection and is often undetected.Untreated cognitive impairment can lead to decreased quality of life.This study aimed to determine the prevalence of cognitive impairment among HIV-infected patients and its associated risk factors. Material and methods:A cross-sectional study was conducted at Wahidin Sudirohusodo Hospital Makassar Indonesia, from October to December 2020.It involved 93 HIV outpatients aged 18-59 years.Cognitive impairment was determined by the Montreal cognitive assessment (MoCA) test.Blood samples were taken for CD4, anti-HCV, and routine blood tests.Nadir (lowest ever) CD4 and antiretroviral therapy (ART) information were obtained from patient medical records.Data were analysed using SPSS version 22.The statistical tests used were the chi-square test and multiple logistic regression. Results:Cognitive impairment was found in 47.3% of subjects.Bivariate analysis found a significant relationship between age 41-59 years (p = 0.025), nadir CD4 count < 200 cells/l (p = 0.001), and anaemia (p = 0.04) with cognitive impairment.Multivariate analysis showed that the most significant factors associated with cognitive impairment were nadir CD4 count < 200 cells/l (OR 4.4; 95% CI: 1.75-11.17)and age 41-59 years (OR 3.0; 95% CI: 1.01-8.73). Conclusions:The prevalence of cognitive impairment was found to be high in HIV-infected adults receiving ART.Low nadir CD4 count (40 years old) was identified as a risk factor associated with impaired cognitive function.

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