Association Between HIV-Associated Neurocognitive Disorders and Cerebrospinal Fluid Viral Load in Patients on Antiretroviral Therapy in Abuja, FCT

HIV-associated neurocognitive disorders (HAND) affect up to 50 percent of HIV-positive individuals globally and persist even in virologically suppressed patients, raising questions about compartment-specific viral replication within the central nervous system (CNS). This analytical cross-sectional study investigated the association between HAND and cerebrospinal fluid (CSF) viral load among virologically suppressed HIV-positive patients attending the ART clinic at the National Hospital Abuja, Federal Capital Territory, in the North Central geopolitical zone of Nigeria. Sixty HIV-positive patients on ART with undetectable plasma viral load (below 50 copies per mL) who underwent diagnostic lumbar puncture for neurological complaints were enrolled. CSF and plasma HIV RNA were measured by real-time RT-PCR. Neurocognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) and HIV Dementia Scale adapted for the Nigerian population. CSF HIV RNA was detectable (above 50 copies per mL) in 36.7 percent of participants, a phenomenon termed CSF viral escape. Participants with detectable CSF viral loads had significantly lower MoCA scores compared to those without. Lower CD4 nadir, longer duration of HIV infection before ART initiation, and older age were significantly associated with CSF viral escape. These findings indicate that CNS viral sanctuary is prevalent in Nigerian HIV patients and underscores the need for CNS-penetrant ART regimens and routine neurocognitive screening in ART clinic protocols. Keywords: HAND, CSF viral load, HIV, Abuja, CNS viral escape.