Objectives:

HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV(PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combina-tion antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimedto estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults underlong-term follow-up in Tanzania and report cognitive comorbidities.

Design:

Longitudinal studyParticipants:A systematic sample of consenting HIV-positive adults aged≥50 years attending routine clinicalcare at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.Measurements:HAND by consensus panel Frascati criteria based on detailed locally normed low-literacyneuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history.Demographic and etiological factors by self-report and clinical records.

Results:

In this cohort (n=253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n=119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these,64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but somereversibility (17.6%, 95% CI 10.0–28.6 n=16) was observed.

Conclusions:

HAND appear highly prevalent in older PLWH in this setting, where demographic profile differsmarkedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high.Future studies should focus on etiologies and potentially reversible factors in this setting.