Prevalence and risk factors of HIV-associated neurocognitive impairment in a vulnerable amazonian population: the impact of socioeconomic status and immune recovery

Background Although antiretroviral therapy (ART) has reduced severe HIV-associated neurological complications, cognitive impairment remains a relevant concern in aging PLWHA and may reflect the combined effects of HIV-related factors, comorbidities, aging, and social vulnerability. This study aimed to estimate the frequency of neurocognitive impairment (NCI) and to explore sociodemographic, clinical, and immune recovery factors associated with NCI among PLWHA in a socially vulnerable Amazonian population. Methods This descriptive cross-sectional study with prospective recruitment was conducted at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil, from January 2023 to December 2024. Adults receiving ART with viral suppression were enrolled. Participants completed sociodemographic and clinical questionnaires and underwent brief cognitive screening using the International HIV Dementia Scale (IHDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA), with functional assessment using the Lawton Instrumental Activities of Daily Living (IADL) scale. NCI categories were defined operationally according to cognitive screening performance and functional impact. Participants with impaired performance on at least one cognitive screening instrument and preserved IADL performance were classified as having asymptomatic NCI, whereas those with impaired cognitive screening performance and reduced IADL performance were classified as having NCI with functional impact. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) as potential confounders but were not used to assign NCI categories. Immune recovery was evaluated using current and historical CD4 + T-cell counts obtained from medical records. Results A total of 72 PLWHA were recruited, and 71 completed the assessments. The median age was 51 years (IQR: 44.75–61.25). Based on the operational screening algorithm, 48 of 71 participants were classified as having NCI, corresponding to 67.6% of the cohort. NCI was more commonly observed among participants with lower income, lower educational attainment, systemic arterial hypertension, and affective symptoms. Among participants with NCI, those with functional impact showed less favorable socioeconomic profiles and lower CD4 + T-cell counts compared with participants classified as asymptomatic NCI. Conclusions In this vulnerable Amazonian cohort of PLWHA, NCI was frequent and associated with socioeconomic vulnerability, comorbidities, and immune recovery markers. These findings should be interpreted as descriptive and exploratory and do not establish formal diagnoses of HIV-associated neurocognitive disorders (HAND) or HIV-specific causality. Integrated care strategies addressing earlier HIV diagnosis, sustained ART, social vulnerability, vascular risk factors, mental health symptoms, and functional decline may be important to reduce neurocognitive risk in this population. Clinical trial number Not applicable.