High prevalence of HIV-associated neurocognitive disorder in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China

Abstract

This study sought to determine the prevalence and risk factors of HIV-associated neurocognitive disorder (HAND) in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China. Subjects were 309 HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL. General demographic and clinical information were collected by patient interview. Patients' cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), combined with a questionnaire on cognitive complaints. The median age of patients was 34 years (IQR: 28-43.5). In terms of sex, 272 (88.0%) of the patients were male. Of the patients, 236 (76.4%) had been on antiretroviral treatment (ART) (for a median duration of 14 months, IQR: 1-29 months) before the study. Of the patients, 183 (59.2%) mentioned having a cognitive disorder. MoCA screening revealed that the prevalence of HAND was 48.2% and that HAND was more prevalent in patients with cognitive complaints (53.0%) than in patients with no such complaints (41.3%) (p = 0.042). Multivariate analysis indicated that HAND was associated with being female (p = 0.006), being older (p < 0.001), having a lower level of education (p < 0.001), and longer use of efavirenz in an ART regimen (p = 0.040). This study found that HAND frequently developed in HIV-infected patients with a baseline CD4 count ≤ 350 cells/μL in Shanghai, China. Being older, being female, having a low level of education, and receiving efavirenz treatment for a longer period may be associated with a greater risk of developing HAND. This study suggests that HAND should be routinely screened for in all newly diagnosed HIV-positive patients, and especially in those with the aforementioned risk factors for developing HAND.