Prevalence and severity of cognitive impairment in HIV- positive adults, with and without antiretroviral therapy

Abstract

Background: There are no data available for HIV-related cognitive impairment for Bulgaria. We report the prevalence of cognitive impairment in a sample of HIV-positive adults with and without antiretroviral therapy. Methods: 101 HIV-infected patients, (18 - 68 years old), 83% male, 17% female, monitored from 2011 to 2014 at the Clinic of Infectious Diseases of the University Hospital in Plovdiv, 88 patients - on antiretroviral therapy, 13 - without treatment were screened for cognitive impairments. The International HIV dementia scale -IHDS; MMSE; Trail Making Test A & B, Digit-Symbol and 10-words tests were used together with clinical interview, standardized neurological examination and detailed laboratory tests. Findings: The literate patients were 78%. The patients with normal neuropsychological test results, without complaints of cognitive problems and with normal neurological examination were 29 (32%). 16 (18%) showed mild neuropsychological impairment, with preserved activities of daily living and neurological function; 29 (32%) had an abnormal performance in at least 3 cognitive tests, influencing the activities of daily living and no changes in the neurological function. 16 (18%) showed serious cognitive impairment and changes in neurological examination (deterioration in the fine motor skills and gait problems). 25% had a mild cognitive impairment, 33% - mild dementia and 1%- moderate dementia (MMSE). 58% had concentration and memory complains. All illiterate patients and 48% of the literate group showed abnormal results from IHDS.Conclusion: Our results show that the assessment of cognitive functioning in HIV-positive patients should be part of their monitoring and treatment at an early stage.