Neurophysiological Assessment of Cognitive Function in HIV-Positive Adults Receiving Antiretroviral Therapy in Enugu State

Cognitive impairment among people living with HIV receiving antiretroviral therapy is increasingly recognised as a significant quality-of-life burden, yet its neurophysiological correlates are poorly documented in Nigerian clinical populations. This study assessed cognitive function and its neurophysiological determinants in HIV-positive adults on antiretroviral therapy attending a treatment centre in Enugu State, South East Nigeria. A cross-sectional comparative study enrolled 90 HIV-positive adults on first-line antiretroviral therapy for at least 12 months and 45 HIV-negative controls. Cognitive function was measured using the Montreal Cognitive Assessment and a computerised neuropsychological battery assessing attention, memory, and processing speed. CD4 count, viral load, haemoglobin, and duration of therapy were extracted from clinical records. Pearson correlation and multiple regression were applied. Results showed that HIV-positive participants scored significantly lower on all cognitive domains compared to controls. CD4 count was positively correlated with cognitive performance, while viral load was inversely associated. Duration of antiretroviral therapy was not independently predictive after controlling for CD4 and viral load. Anaemia significantly worsened cognitive outcomes. The study fills a gap in understanding HIV-related neurocognitive dysfunction in South East Nigeria, demonstrating that immune status rather than treatment duration drives cognition. Routine cognitive screening and anaemia management in HIV care programmes are strongly recommended. Keywords: HIV, antiretroviral therapy, cognitive function, CD4 count, Enugu State.