BACKGROUND: Despite broad access to antiretroviral therapy in sub-Saharan Africa (SSA), neurocognitive comorbidities remain common among people with HIV (PWH). Multiple lines of evidence link cognitive performance to inflammatory plasma biomarkers. This study examined this relationship within a robust sample in SSA.

METHODS: PWH and people without HIV (PWoH) aged 18 years or older, enrolled in the prospective African Cohort Study from 2013 to 2016 at multiple sites across Kenya, Nigeria, Tanzania, and Uganda, and underwent clinical evaluation. A neuropsychological battery assessed cognitive performance. Blood samples collected were analyzed by immunoassay. Using multivariable linear regression, we characterized associations between cognitive Z-scores and biomarker levels.

RESULTS: Participants included PWoH (17%, n = 473), PWH with suppressed viremia (44%, n = 1199), and PWH with unsuppressed viremia (exceeding 100 copies/mL, 39%, n = 1065). Across groups, PWH with suppressed viremia were significantly older (means = 37.1, 41.9 and 37.5, respectively, P < 0.001). Among PWH, 3 biomarkers (CXCL10, CCL2, and sCD25) showed inverse relationships to cognitive performance on all measures (β = -0.163, β = -0.133, and β = -0.204, respectively, P < 0.05). Inflammation did not relate to cognitive performance in PWoH. Examining individual neuropsychological test performance, the Grooved Pegboard, measuring psychomotor speed and manual dexterity, displayed the strongest associations with key biomarkers (CCL2 β = -0.252, sCD25 β = -0.293, and CXCL10 β = -0.214, P < 0.01).

CONCLUSIONS: In SSA, inflammatory markers associated with worse cognitive performance in both viremic and suppressed PWH.