Dementia risk higher among adults with HIV in Malawi

Adults who live with HIV in Malawi have more than twice as much chance of having dementia compared to those without HIV, according to a new study by a team of us and Malawian researchers.

Their findings published in the magazine Alzheimer and dementiashed light on the important burden of dementia in people who live with HIV in Malawi and the importance of studying dementia in institutions for resources with limited access to health care.

Thanks to progress in the treatment of HIV with anti -retroviral therapy, people with HIV live a longer life. But aging with HIV comes with challenges, because the virus increases the opportunities to develop other age -related diseases prematurely, including diabetes, heart disease and cancer. Due to inflammation and other changes in the brain, HIV also increases the risk of dementia.

In the Southeast African country of Malawi, 8 to 12 percent of adults with HIV live and it remains the most important cause of death. However, life expectancy has improved dramatically in recent decades: according to the World Health Organization, a child born in 2000 will only live up to 45, while a child born in 2021 will probably live up to 63. With the aging population of Sub-Sahara Africa, experts predict an increase in dementia in the coming decades.

The majority of what we know about dementia and Alzheimer’s disease come from research studies in high -income countries, but there is less known about dementia prevalence and risk in countries with low and middle income. “

Haeok Lee, professor at the NYU Rory Meyers College of Nursing and Study’s Lead Author

To better understand the prevalence of dementia in people in Malawi with and without HIV, the researchers have assessed medical records of 400 adult patients aged 30 and older in an outpatient clinic in Lilongwe, the capital of Malawi. Half of the participants lived with HIV and took antiretroviral therapy, while the other half had no HIV.

The researchers discovered that 22 percent of people with HIV had dementia compared to 10 percent of those without HIV. Although the prevalence of dementia in both groups increased with age, the increase was faster in people with HIV, who was also diagnosed with dementia at a younger age.

In addition to older age, depression was a significant risk factor for dementia for both people with and without HIV. For people who live with HIV, unstable employment also increased the opportunities for developing dementia.

The researchers warn that there are restrictions on the use of medical files to understand the prevalence and risk of dementia in Malawi, including the challenges of analyzing paper graphs (no electronic files), a lack of standardized diagnostic codes and no data on alcohol and substance use. Due to the shortage of care providers in the country, moreover, only one neurologist in the entire adult population is probably that dementia is not diagnosed enough due to a lack of screening.

“We have to do more to take care of us for patients with dementia in low and middle income countries,” said Study author Jonathan Ngoma of the Kamuzu Central Hospital and Malawi Ministry of Health. “We started a trip to bring a lot of information to the world.”

“Our findings emphasize an urgent need to develop infrastructure for the management of dementia for both people who live with HIV and the general population in Malawi, including culturally tested cognitive assessment instruments and treatment guidelines that are tailored to Malawians and the local health care system,” added.

The study will appear in a special issue of Alzheimer and dementia Focus on dementia research in Africa. In addition to Lee and Ngoma, study authors Yohannie Mlombe of Kamuzu University of Health Sciences; Yeunjoo Song of Case Western Reserve University School of Medicine; Hyun-Sik Yang from Brigham and Women’s Hospital and Harvard Medical School; Tiwonge Phiri of the Malawi Ministry of Health and Queen Elizabeth Central Hospital; Joseph Maseke and Esther Bauleni from Daeyang University in Malawi; Gyungah Jun from Boston University; and Yun-Beom Choi from Rutgers Medical School.