A cross-sectional study of the association between cognitive impairment and haemoglobin levels in HIV-infected South Africans established on antiretroviral therapy

Master Thesis


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Background Sub-Saharan Africa, the epicenter of the global population of people living with HIV (PLHIV), is estimated to have more than 25 million PLHIV. In the era before the widespread availability of antiretroviral therapy (ART), anaemia (low serum haemoglobin) was a common clinical finding that was seen as a potential risk factor for HIV-associated neurocognitive impairment. The association between haemoglobin levels and neurocognitive function has not been assessed in a Sub-Saharan study population in the era of ART. Methods A cross-sectional secondary data analysis was performed to assess the association between serum haemoglobin level and neurocognitive function in 129 participants who had both neurocognitive test (global deficit score) and full blood count results performed as part of a randomised placebo controlled trial that evaluated the efficacy of lithium carbonate for the treatment of HIV associated neurocognitive disorders. Results The majority of our participants were female (87%) with a mean age of 37 ±7.78 years. Participants were all established on ART with a median CD4 count of 495 cells/µL (IQR=315- 629). The median haemoglobin level was 12.2 (IQR=11.6-13.00) and anaemia was present in 8.5%. Serum haemoglobin level was not associated with global deficit scores (GDS) and fewer years of education was the only independent risk association for GDS-defined neurocognitive impairment. Conclusion We found that in South Africans, who are established on ART, anaemia is less common than in the pre-ART era and importantly, that low-normal serum Hb levels do not present a risk for GDS-defined neurocognitive impairment. These findings are relevant as they show that aggressive management of low-normal Hb levels is not necessary provided individuals are otherwise clinically well and virally suppressed.