Risk factors for HIV-associated neurocognitive disorders (HAND) in sub-Saharan Africa: The case of Yaoundé-Cameroon

Abstract: Background: The prevalence of HIV-associated neurocognitive disorders (HAND), especially HIV-associated dementia (HAD) is influenced by several risk factors. The prevalence as well as risk factors for HAD are not well known in sub-Saharan Africa (SSA). We have shown that the International HIV Dementia Scale (IHDS) is a useful screening tool for HAND in Yaoundé [Njamnshi AK, Djientcheu VdP, Fonsah JY, Yepnjio FN, Njamnshi DM, Muna WFT. The IHDS is a useful screening tool for HAD/Cognitive Impairment in HIV-infected adults in Yaoundé-Cameroon. Journal of Acquired Immune Deficiency Syndromes 2008;49(4):393–397], but no study in Cameroon has yet investigated the risk factors for HAND or HAD. Patients and methods: A cross-sectional study was conducted in Yaoundé, the capital of Cameroon from September to December 2006. One hundred and eighty-five HIV-positive subjects were included. Diagnosis of HAND was done using the IHDS with a score ≤10 considered as abnormal. Age, sex, level of education, IV drug use, body mass index (BMI), CDC clinical stage, CD4 counts, hemoglobin levels, administration of highly active antiretroviral therapy (HAART) and type of regimen used, were considered in univariate analysis, with level of significance set at P ≤0.05. A binary logistic regression was used to determine independent risk factors. Results: The following factors were independent predictors of HAND: advanced clinical stage (OR=7.43, P =0.001), low CD4 count especially CD4≤200 cells/µL (OR=4.88, P =0.045) and low hemoglobin concentration (OR=1.16, P =0.048). Conclusion: This first study of the risk factors for HAND in Yaoundé-Cameroon shows findings similar to those described in other studies. These results call for rapid action by policy makers to include HAND prevention strategies such as providing early universal access to HAART based on these risk factors, in the management of HIV patients at risk of HAND in resource-limited settings of SSA like ours. [Copyright &y& Elsevier]