Neurocognitive Effects of Antiretroviral Initiation among People Living with HIV in Rural Uganda

Alyssa Vecchio, Kevin Robertson, Deanna Saylor, Gertrude Nakigozi, Noeline Nakasujja, Alice Kisakye, James Batte, Richard Mayanja, Aggrey Anok, Steven J. Reynolds, Thomas C. Quinn, Ronald Gray, Maria J. Wawer, Ned Sacktor, Leah H. Rubin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background:HIV-associated neurocognitive disorders remain prevalent despite effective antiretroviral therapy (ART), but there are limited longitudinal data on people living with HIV (PLWH) in sub-Saharan Africa. We examined neuropsychological (NP) performance in PLWH in a longitudinal study in Uganda.Methods:Participants enrolled through the Rakai Community Cohort Study (400 ART-naive PLWH and 400 matched HIV-negative persons) were administered NP assessments. In 2017, PLWH who had initiated ART underwent a 2-year follow-up assessment. Demographically adjusted Z-scores for each NP test were established using data from the HIV-controls. Multivariable linear and logistic regressions were conducted to examine group differences in NP performance. Mixed-effects regressions were conducted to examine ART-related changes in NP outcomes.Results:Of 333 PLWH who returned for their 2-year follow-up visit, 312 (94%) had initiated ART. Those on ART had a mean age of 35.6 years (SD ± 8.5 years) and mean education of 5.4 years (SD ± 3.3 years); 49% were women. ART-associated NP improvements occurred in verbal learning and memory (P's < 0.05), motor (P's < 0.01), and some measures of processing speed (P = 0.002), whereas there were declines in attention/working memory (P's < 0.001) and semantic fluency (P < 0.001). Pre-ART CD4 count and efavirenz use were associated with a more impaired change in NP performance.Conclusions:PLWH in this resource-limited setting showed improved neurocognitive performance on most NP tests after ART initiation. However, the declines in attention/working memory and fluency performance, as well as relationship to efavirenz, warrant further study.

Original languageEnglish (US)
Pages (from-to)534-542
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - Aug 15 2020


  • ART
  • HIV
  • HIV-associated neurocognitive disorders
  • neuropsychology
  • resource-limited areas

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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