Abstract:
HIV-associated neurocognitive disorder (HAND) is an important sequela of HIV infection. Combined
antiretroviral therapy (cART) has improved the health outcomes of many people living with HIV but
has given rise to a less severe but limiting form of HAND. The study aimed to evaluate the impact
of HAND on medication adherence, activities of daily living (ADL), quality of life and frailty. This
systematic review adheres to the guidelines for Preferred Reporting Items for Systematic Reviews
and Meta-Analyses. We searched MEDLINE, PubMed, CINAHL, Academic Search Complete, and
PsycINFO online databases. Studies were included if they examined the relationship between HAND
and medication adherence, ADL, quality of life and frailty, and were conducted between 1997 and
2021. We used a random-efects meta-analysis model to assess the impact of HAND on outcome
variables. Forty papers, totaling 11,540 participants, were included in the narrative and quantitative
syntheses. Cognitive impairment was associated with poorer medication adherence (r= 0.601, CI 0.338
to 0.776, p = 0.001, I
2 = 94.66). Cognitive impairment did not infuence ADL (r = 0.167, CI-0.215 to 0.505,
p = 0.393) and quality of life (r = 0.244, CI 0.117 to 0.548, p = 0.182). In the cART era, HAND appears to
be associated with adherence to medication, which may infuence future health outcomes. In PLWHIV
who are adherent to cART, cognitive impairment does not appear to interfere with ADL and quality of
life.
