Factors associated with neurocognitive disorders in people living with HIV aged ≥ 50 years old in Brazil: a cross-sectional study
Main Article Content
Abstract
Introduction: There is a high prevalence of HIV-associated neurocognitive disorders (HAND), especially in people living with HIV (PLWH) who are ≥50 years old. Objective: The objective of this study was to identify the factors associated with HAND in PLWH who are ≥50 years old. Methods: This is a cross-sectional study involving 48 patients (Mean=59.6 years). We collected sociodemographic, clinical, and anthropometric data, and the instrumental activities of daily living (IADL) and International HIV Dementia Scale (IHDS) were administered for neurocognitive evaluation. Results: A total of 75% of individuals had HANDs, including 88.89% with asymptomatic disorders and 11.11% with mild/moderate disorders. IHDS scores were positively correlated with educational level, nutritional status, and viral load (VL) at the time of diagnosis, while negatively correlated with the number of diseases, number of medications, and blood glucose levels. Conclusion: To the best of our knowledge, this is one of few studies conducted exclusively with elderly PLWH that investigated the factors associated with HAND in an inland city from a developing country, showing that the main predictors of HANDs were education, VL at diagnosis, and blood glucose. Hence, results could support future studies and interventions among PLWH elsewhere, where resources are limited and HIV assistance may be more precarious and difficult.
Downloads
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Righetto RC, Reis RK, Reinato LAF, Gir E. Comorbidades e coinfecções em pessoas vivendo com HIV/Aids. Rev Rene. 2014;15(6):942-8. https://doi.org/10.15253/2175-6783.2014000600006
Rojas-Celis V, Valiente-Echeverría F, Soto-Rifo R, Toro-Ascuy D. New Challenges of HIV-1 Infection: How HIV-1 Attacks and Resides in the Central Nervous System. Cells. 2019;8(10):1245. https://doi.org/10.3390/cells8101245
Sartori GP, Domínguez CI, Rodríguez VGF, Dansilio S, Presentado JCM. Trastornos neurocognitivos en pacientes VIH positivos. Datos preliminares de una cohorte prospectiva uruguaya. Rev Med Urug. 2019;35(3):5-30. https://doi.org/10.29193/rmu.35.3.1
Eggers C, Arendt G, Hahn K, Husstedt IW, Maschke M, Neuen-Jacob E, et al. HIV-1-associated neurocognitive disorder: epidemiology, pathogenesis, diagnosis, and treatment. J Neurol. 2017;264(8):1715-27. https://doi.org/10.1007/s00415-017-8503-2
Smail RC, Brew BJ. Chapter 7 - HIV-associated neurocognitive disorder. Handb Clin Neurol. 2018;152:75-97. https://doi.org/10.1016/B978-0-444-63849-6.00007-4
Xiao X, Zeng H, Feng C, Tan H, Wu L, Zhang H, et al. Cognitive Impairment Among Aging People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Hunan, China. J Assoc Nurses AIDS Care. 2020;31(3):301-11. https://doi.org/10.1097/JNC.0000000000000122
Mohamed AA, Oduor C, Kinyanjui D. HIV-associated neurocognitive disorders at Moi teaching and referral hospital, Eldoret, Kenya. BMC Neurol. 2020;20(1):280. https://doi.org/10.1186/s12883-020-01857-3
Rosca EC, Tadger P, Cornea A, Tudor R, Oancea C, Simu M. International HIV Dementia Scale for HIV-Associated Neurocognitive Disorders: A Systematic Review and Meta-Analysis. Diagnostics (Basel). 2021;11(6):1124. https://doi.org/10.3390/diagnostics11061124
Freitas EV, Miranda RD. Parâmetros clínicos do envelhecimento e avaliação geriátrica ampla. In: Tratado de geriatria e gerontologia. 2nd ed. Rio de Janeiro: Guanabara Koogan; 2016.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. https://doi.org/10.1186/s12877-017-0621-2
Vale FC, Santa-Helena ET, Santos MA, Carvalho WMES, Menezes PR, Basso CR, et al. Development and validation of the WebAd-Q Questionnaire to monitor adherence to HIV therapy. Rev Saude Publica. 2018;52:62. https://doi.org/10.11606/S1518-8787.2018052000337
Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature- What does it tell us? J Nutr Health Aging. 2006;10(6):466-85.
Rodrigues RA, Oliveira RL, Grinsztejn B, Silva MTT. Validity of the International HIV Dementia Scale in Brazil. Arq Neuro-Psiquiatr. 2013;71(6):376-9.
Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-22. https://doi.org/10.1016/s0899-9007(98)00171-3
Paradela EMP, Lourenço RA, Veras RP. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saude Pública. 2005;39(6):918-23. https://doi.org/10.1590/S0034-89102005000600008
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23. https://doi.org/10.1093/ageing/afq034
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. https://doi.org/10.1093/gerona/56.3.m146
Lima LRA, Rech CR, Petroski EL. Utilização da impedância bioelétrica para estimativa da massa muscular esquelética em homens idosos. ALAN. 2008;58(4):386-91.
Rech CR, Salomons E, Lima LRA, Petroski EL, Glaner MF. Validity of bioelectrical impedance analysis for the estimation of skeletal muscle mass in elderly women. Rev Bras Med Esporte. 2010;16(2):95-8. https://doi.org/10.1590/S1517-86922010000200003
Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol (1985). 2000;89(2):465-71. https://doi.org/10.1152/jappl.2000.89.2.465
Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, et al. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS. 2005;19(13):1367-74.
Duarte EAC, Benevides ML, Martins ALP, Duarte EP, Weller ABS, Azevedo LOC, et al. Female sex is strongly associated with cognitive impairment in HIV infection. Neurol Sci. 2021;42(5):1853-60. https://doi.org/10.1007/s10072-020-04705-x
Animut MD, Sorrie MB, Birhanu YW, Teshale MY. High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: A cross-sectional study. Plos One. 2019;14(3):e0204636. https://doi.org/10.1371/journal.pone.0204636
Mugendi AG, Kubo MN, Nyamu DG, Mwaniki LM, Wahome SK, Haberer JE. Prevalence and Correlates of Neurocognitive Disorders among HIV Patients on Antiretroviral Therapy at a Kenyan Hospital. Neurol Res Int. 2019;2019:5173289. https://doi.org/10.1155/2019/5173289
Lawton MP, Brody EM. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. Gerontologist. 1969;9(3):179-86.
Chan FCC, Chan P, Chan I, Chan A, Tang THC, Lam W, et al. Cognitive screening in treatment-naïve HIV-infected individuals in Hong Kong - a single center study. BMC Infect Dis. 2019;19(1):156. https://doi.org/10.1186/s12879-019-3784-y
Pinheiro CAT, Souza LDM, Motta JVS, Kelbert EF, Martins CSR, Souza MS, et al. Aging, neurocognitive impairment, and adherence to antiretroviral therapy in human immunodeficiency virus-infected individuals. Braz J Infect Dis. 2016;20(6):599-604. https://doi.org/10.1016/j.bjid.2016.09.006
Milanini B, Allen I, Paul R, Bahemana E, Kiweewa F, Nambuya A, et al. Frequency and Predictors of HIV-Related Cognitive Impairment in East Africa: The Africa Cohort Study (AFRICOS). J Acquir Immune Defic Syndr. 2020;83(2):157-64. https://doi.org/10.1097/QAI.0000000000002242
Mohamed AA, Oduor C, Kinyanjui D. HIV-associated neurocognitive disorders at Moi teaching and referral hospital, Eldoret, Kenya. BMC Neurol. 2020;20(1):280. https://doi.org/10.1186/s12883-020-01857-3
Haddow LJ, Laverick R, Daskalopoulou M, McDonnell J, Lampe FC, Gilson R, et al. Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients. AIDS Behav. 2018;22(5):1573-83. https://doi.org/10.1007/s10461-017-1683-z
Nyamayaro P, Gouse H, Hakim J, Robbins RN, Chibanda D. Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe. BMC Infect Dis. 2020;20(1):383. https://doi.org/10.1186/s12879-020-05090-8
Gascon MR, Lima M, Cheutchuk PM, Oliveira EA, Oliveira GS, Gualqui CF, et al. High prevalence of HIV-associated neurocognitive disorders (HAND) in São Paulo City, Brazil. Rev Bras Neurol. 2021;57(1):6-12. https://doi.org/10.46979/rbn.v57i1.43075
Távora LGF, Figueiredo TM, Mesquita RMK, Bezerra FR, Aquino BP, Colares JKB. HIV and dementia: Prevalence and risk factors. Rev Bras Promoç Saude. 2016;29(2):212-8. https://doi.org/10.5020/18061230.2016.p212
Sun-Suslow N, Paolillo EW, Morgan EE, Letendre S, Iudicello J, Moore DJ. Brief Report: Frailty and HIV Disease Severity Synergistically Increase Risk of HIV-Associated Neurocognitive Disorders. Acquire Immune Defic Syndr. 2020;84(5):522-6. https://doi.org/10.1097/QAI.0000000000002391
Yuan NY, Kaul M. Beneficial, and Adverse Effects of cART Affect Neurocognitive Function in HIV-1 Infection: Balancing Viral Suppression against Neuronal Stress and Injury. J Neuroimmune Pharmacol. 2021;16(1):90-112. https://doi.org/10.1007/s11481-019-09868-9
Valcour V, Shikuma C, Shiramizu B, Watters M, Poff P, Selnes O, et al. Higher frequency of dementia in older HIV-1 individuals: The Hawaii Aging with HIV-1 Cohort. Neurology. 2004;63(5):822-7. https://doi.org/10.1212/01.wnl.0000134665.58343.8d
Banerjee N, McIntosh RC, Ironson G. Impaired Neurocognitive Performance and Mortality in HIV: Assessing the Prognostic Value of the HIV-Dementia Scale. AIDS Behav. 2019;23(12):3482-92. https://doi.org/10.1007/s10461-019-02423-w
Joska JA, Dreyer AJ, Nightingale S, Combrinck MI, Jager CA. Prevalence of HIV-1 Infection in an elderly rural population and associations with neurocognitive impairment. AIDS. 2019;33(11):1765-71. https://doi.org/10.1097/QAD.0000000000002257
Mone P, Gambardella J, Pansini A, Donato A, Martinelli G, Boccalone E, et al. Cognitive Impairment in Frail Hypertensive Elderly Patients: Role of Hyperglycemia. Cells. 2021;10(8):2115. https://doi.org/10.3390/cells10082115
Herzlich BC, Schiano TD. Reversal of apparent AIDS dementia complex following treatment with vitamin B12. J Intern Med. 1993;233(6):495-7. https://doi.org/10.1111/j.1365-2796.1993.tb01005.x