Maternal weight and hypertension as risk factors for juvenile idiopathic arthritis: a prospective population-based pregnancy cohort study.

Probable HIV dementia (PHD), the most severe form of HIV-associated neurocognitive disorders (HAND), is a progressive subcortical syndrome characterized by impairments in memory, attention, psychomotor speed, and executive function, ultimately leading to significant functional disability. The pathophysiology of HAND is complex, involving neuroinflammation, synaptic pathology, and neuronal death driven by the toxic effects of HIV viral proteins, including transactivator of transcription (Tat) and glycoprotein 120 (gp120), which compromise blood-brain barrier integrity and facilitate HIV penetration into the brain parenchyma. HIV primarily infects macrophages and microglia rather than neurons, establishing reservoirs within subcortical and cortical structures, with the extent of neuronal damage correlating directly with the severity of dementia. Although combination antiretroviral therapy (ART) has substantially reduced PHD incidence, the overall prevalence of neurocognitive impairment in people living with HIV (PLWH) remains high despite effective ART, with persistent low-level viral replication, HIV-related neuroinflammation, and potential Alzheimer’s disease-like pathology contributing to ongoing neuronal injury. Among PLWH on dolutegravir (DTG)-based regimens, metabolic complications further amplify this neurocognitive burden. The global burden of probable HIV dementia (PHD) remains substantial and disproportionately concentrated in Sub-Saharan Africa. A recent systematic review reported a global HAND prevalence of 42.6% among PLWH, with PHD accounting for a minority of cases while milder forms predominate. The highest HIV prevalence globally is estimated in the African region, where approximately 1 in 25 adults are HIV-positive, accounting for over two-thirds of PLWH worldwide. In Sub-Saharan Africa, the reported prevalence of HIV-related dementia ranges from 0% to 80% across studies, reflecting profound heterogeneity in populations, diagnostic tools, and disease staging. In East Africa, screening for HAND among HIV clinic attendees in Tanzania identified high proportions of cognitive impairment using the International HIV Dementia Scale (IHDS). In Uganda specifically, 31% of HIV-positive patients attending an ambulatory HIV clinic in Kampala were found to have HIV dementia, with advanced age and low CD4 count identified as the only significant risk factors. Strikingly, a cross-sectional study of 680 HIV clinic attendees in Uganda reported a PHD prevalence of 64.4%, with increasing stress scores and psychosocial impairment as significant contributing factors. Failure to diagnose and manage PHD early carries grave clinical consequences. The gradual loss of mental clarity and physical coordination severely reduces quality of life, and without treatment, HIV-associated dementia can be fatal. Unrecognized neurocognitive impairment compromises medication adherence, accelerating immunological decline and increasing the risk of opportunistic infections and mortality. With the majority of PLWH being asymptomatic, screening for HAND remains extremely limited in clinical settings, meaning that many patients silently deteriorate without timely intervention. In resource-limited settings such as Uganda, the downstream social and economic burden of unmanaged PHD including loss of employment, caregiver dependency, and family disintegration compounds the already significant HIV-related morbidity.