Background
Decline in verbal fluency, observed both in aging and HIV infection, is associated with reduced quality of life. The association of cardiometabolic diseases with verbal fluency is well described in Western Countries, not in Sub-Saharan Africa, especially in older people living with HIV (PLWH). This study aims to identify the factors associated with verbal fluency performance in older PLWH in West Africa.
Methods
PLWH aged ≥50 years and on antiretroviral therapy since ≥6 months were enrolled as part of a prospective, longitudinal, multicenter study conducted at two HIV-clinics (SMIT, CTA) in Dakar, Senegal. Sociodemographic characteristics, depressive symptoms and cardio-metabolic disorders including hypertension, diabetes and dyslipidemia were measured at enrollment. Verbal fluency was assessed with the Isaacs Set Test (IST) which consists in giving as many words as possible from a specific semantic category (« animals ») in 15 seconds. Factors associated with verbal fluency performance at enrollment were evaluated with multivariate linear regressions (backward selection, significance p<0.05). Age, gender, education level and HIV clinics were retained due to their importance, independently of significance.
Results
The median age of the 290 PLWH included in this study was 58 years (IQR: 53-62), 67% were female, 68% had a low education level, 50% had hypertension, 63% had dyslipidemia, 14% were diabetic, 6.5% had depressive symptoms, 9.5% had a detectable viral load (<50 copies/ml) and the median CD4 was 690 cell/mm3 (IQR: 500-900). In the final model, low IST-15-seconds scores were significantly associated with hypertension (β=-0.3, p=0.01), female sex (β=-0.8, p= <0.001), low educational level (β=-0.3, p=0.05) and HIV-clinics (β=-0.6, p=<0.001). No association was observed in this final model with other sociodemographic characteristics (i.e. age, marital status or professional activity), cardiometabolic disorders (i.e. diabetes or dyslipidemia) and specific HIV clinical outcomes (i.e. CD4 count or viral load).
Conclusions
Among older West African PLWH, after adjusting for usual socio-demographic determinants, low verbal fluency performance was associated with hypertension. This underscores the urgent need for effective hypertension monitoring and treatment in this population, given the high prevalence of hypertension.
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