Effect of HIV Subtype and Antiretroviral therapy on HIV-associated neurocognitive disorder (HAND) stage in Rakai, Uganda.

BACKGROUND: Combination antiretroviral therapy (ART) improves HIV-associated neurocognitive disorder (HAND) stage in the US where subtype B predominates, but the effect of ART and subtype on HAND stage in individuals in Uganda with subtypes D and A is largely unknown.

SETTING: A community-based cohort of participants residing in Rakai, Uganda.

METHODS: 399 initially ART-naive HIV-seropositive (HIV+) individuals were followed over two years. Neurological, neuropsychological test and functional assessments were used to determine HAND stage. Frequency and predictors of HAND and HIV-associated dementia (HAD) were assessed at baseline and at follow-up after ART initiation in 312 HIV+ individuals. HIV subtype was determined from gag and env sequences.

RESULTS: At two year follow-up, HAD frequency among HIV+ individuals on ART (n=312) decreased from 13% to 5% (p<0.001), but the overall frequency of HAND remained unchanged (56% to 51%). Subtype D was associated with higher rates of impaired cognition (global deficit score ≥ 0.5) compared to HIV+ individuals with subtype A (55% vs. 24%) (p= 0.008). Factors associated with HAD at baseline were older age, depression and plasma HIV viral load > 100,000 copies/mL. At follow-up, age and depression remained significantly associated with HAD.

CONCLUSION: HIV+ individuals on ART in rural Uganda had a significant decrease in the frequency of HAD, but HAND persists after two years on ART. The current guideline of immediate ART initiation after HIV diagnosis is likely to greatly reduce HAD in Sub-Saharan Africa. Further studies of the effect of HIV subtype and neurocognitive performance are warranted.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.