Alyssa Vecchio1, Kevin Robertson1, Deanna Saylor2, Gertrude Nakigozi3, Noeline Nakasujja4, Alice Kisakye4, James Batte4, Richard Mayanja4, Aggrey Anok4, Steven J Reynolds5, Thomas C Quinn5,6, Ronald Gray7, Maria J Wawer7, Ned Sacktor2, Leah H Rubin2,7,8. 1. Department of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, NC. 2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Psychiatry, Makerere University, Kampala, Uganda. 4. Rakai Health Sciences Program (RHSP), Rakai Health Sciences Program, Kalisizo, Uganda. 5. Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD. 6. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and. 8. Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: HIV-associated neurocognitive disorders remain prevalent despite effective antiretroviral therapy (ART), but there are limited longitudinal data on people living with HIV (PLWH) in sub-Saharan Africa. We examined neuropsychological (NP) performance in PLWH in a longitudinal study in Uganda. METHODS: Participants enrolled through the Rakai Community Cohort Study (400 ART-naive PLWH and 400 matched HIV-negative persons) were administered NP assessments. In 2017, PLWH who had initiated ART underwent a 2-year follow-up assessment. Demographically adjusted Z-scores for each NP test were established using data from the HIV- controls. Multivariable linear and logistic regressions were conducted to examine group differences in NP performance. Mixed-effects regressions were conducted to examine ART-related changes in NP outcomes. RESULTS: Of 333 PLWH who returned for their 2-year follow-up visit, 312 (94%) had initiated ART. Those on ART had a mean age of 35.6 years (SD ± 8.5 years) and mean education of 5.4 years (SD ± 3.3 years); 49% were women. ART-associated NP improvements occurred in verbal learning and memory (P's < 0.05), motor (P's < 0.01), and some measures of processing speed (P = 0.002), whereas there were declines in attention/working memory (P's < 0.001) and semantic fluency (P < 0.001). Pre-ART CD4 count and efavirenz use were associated with a more impaired change in NP performance. CONCLUSIONS: PLWH in this resource-limited setting showed improved neurocognitive performance on most NP tests after ART initiation. However, the declines in attention/working memory and fluency performance, as well as relationship to efavirenz, warrant further study.
BACKGROUND: HIV-associated neurocognitive disorders remain prevalent despite effective antiretroviral therapy (ART), but there are limited longitudinal data on people living with HIV (PLWH) in sub-Saharan Africa. We examined neuropsychological (NP) performance in PLWH in a longitudinal study in Uganda. METHODS:Participants enrolled through the Rakai Community Cohort Study (400 ART-naive PLWH and 400 matched HIV-negative persons) were administered NP assessments. In 2017, PLWH who had initiated ART underwent a 2-year follow-up assessment. Demographically adjusted Z-scores for each NP test were established using data from the HIV- controls. Multivariable linear and logistic regressions were conducted to examine group differences in NP performance. Mixed-effects regressions were conducted to examine ART-related changes in NP outcomes. RESULTS: Of 333 PLWH who returned for their 2-year follow-up visit, 312 (94%) had initiated ART. Those on ART had a mean age of 35.6 years (SD ± 8.5 years) and mean education of 5.4 years (SD ± 3.3 years); 49% were women. ART-associated NP improvements occurred in verbal learning and memory (P's < 0.05), motor (P's < 0.01), and some measures of processing speed (P = 0.002), whereas there were declines in attention/working memory (P's < 0.001) and semantic fluency (P < 0.001). Pre-ART CD4 count and efavirenz use were associated with a more impaired change in NP performance. CONCLUSIONS: PLWH in this resource-limited setting showed improved neurocognitive performance on most NP tests after ART initiation. However, the declines in attention/working memory and fluency performance, as well as relationship to efavirenz, warrant further study.
Authors: Alyssa C Vecchio; Dionna W Williams; Yanxun Xu; Danyang Yu; Deanna Saylor; Sarah Lofgren; Riley O'Toole; David R Boulware; Noeline Nakasujja; Gertrude Nakigozi; Alice Kisakye; James Batte; Richard Mayanja; Aggrey Anok; Steven J Reynolds; Thomas C Quinn; Ronald H Gray; Maria J Wawer; Ned Sacktor; Leah H Rubin Journal: Brain Behav Immun Date: 2020-12-24 Impact factor: 7.217
Authors: Pragney Deme; Leah H Rubin; Danyang Yu; Yanxun Xu; Gertrude Nakigozi; Noeline Nakasujja; Aggrey Anok; Alice Kisakye; Thomas C Quinn; Steven J Reynolds; Richard Mayanja; James Batte; Maria J Wawer; Ned C Sacktor; Deanna Saylor; Norman J Haughey Journal: Viruses Date: 2022-06-15 Impact factor: 5.818
Authors: Noeline Nakasujja; Alyssa C Vecchio; Deanna Saylor; Sarah Lofgren; Gertrude Nakigozi; David R Boulware; Alice Kisakye; James Batte; Richard Mayanja; Aggrey Anok; Steven J Reynolds; Thomas C Quinn; Carlos A Pardo; Anupama Kumar; Ronald H Gray; Maria J Wawer; Ned Sacktor; Leah H Rubin Journal: J Neurovirol Date: 2021-07-31 Impact factor: 3.739