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/μl (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/μl (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.