HIV-associated neurocognitive dysfunction in the Chugoku-Shikoku region of Japan: A cross-sectional study

Although combination antiretroviral therapy (cART) is widely used, HIV-associated neurocognitive disorder (HAND) remains a significant challenge for people living with HIV. This study aimed to investigate the characteristics of HAND among HIV patients in the Chugoku-Shikoku region of Japan using the CoCoBattery, a unified neurocognitive test employed in a nationwide multicenter prospective cross-sectional study on HAND.

A cross-sectional study was conducted in seven general hospitals from January 2019 to March 2023, including 103 HIV patients. HAND was classified into HIV-associated dementia (HAD), mild neurocognitive disorder (MND), and asymptomatic neurocognitive impairment (ANI, asymptomatic HAND) based on the Frascati criteria. Multivariable logistic regression analysis was performed to identify factors associated with HAND and asymptomatic HAND.

Among the 103 patients, 62 (60.2 %) were diagnosed with HAND, including 11 (10.7 %) with HAD, 16 (15.5 %) with MND, and 35 (34.0 %) with ANI. No significant differences in baseline characteristics were observed between the HAND and non-HAND groups. However, a positive association was observed between an HIV-RNA copy number ≥200 copies/mL and asymptomatic HAND (adjusted odds ratio (OR): 11.15; 95 % confidence interval (CI): 1.13-297.17). Notably, 10 ANI patients exhibited neurocognitive impairment equivalent to HAD.

ANI accounted for a large proportion of HAND cases and included patients with significant neurocognitive impairment. Elevated HIV-RNA copy numbers were associated with ANI, highlighting the need for careful monitoring and support for these patients, even in the absence of subjective symptoms.