Identifying the burden of neurocognitive impairment in people living with HIV: A cross-sectional analysis of prevalence and predictors in an Indian antiretroviral therapy centre

Background: Neurocognitive impairment remains a significant complication in people living with HIV (PLWH) despite widespread antiretroviral therapy (ART). Mild-to-moderate forms persist and are often underdiagnosed, yet regional data from Western India remain limited. Aims: To determine the prevalence of Montreal Cognitive Assessment (MoCA)-defined cognitive impairment and identify associated correlates at a tertiary ART centre in South Gujarat, India. Materials and Methods: We conducted a cross-sectional study of 231 HIV-positive adults over 6 months. Participants were assessed using MoCA (threshold <26), and those with impaired cognition were further characterised using the Frascati criteria as a descriptive severity framework. Sociodemographic variables, ART history, CD4 counts and comorbidities were evaluated using SPSS version 25 ( P < 0.05 significant). Results: The prevalence of MoCA-defined cognitive impairment was 22.07% ( n = 51), representing a likely ceiling estimate given the uniform cutoff applied without education-based adjustment. Most patients presented with an asymptomatic-range profile (18.61%); 3.46% had a mild impairment profile, and none demonstrated severity consistent with HIV-associated dementia. Significant correlates included lower CD4 count ( P < 0.001), shorter ART duration ( P = 0.0004), tuberculosis history ( P = 0.0351), opportunistic infections ( P < 0.001), lower haemoglobin ( P < 0.001) and prior hospitalisation ( P = 0.0001). Lower educational attainment and low socioeconomic status showed non-significant trends. Conclusions: Cognitive impairment affects a substantial proportion of ART-treated individuals. Findings support early ART initiation and cognitive screening; however, causality cannot be inferred from this cross-sectional design. Future studies should incorporate depression screening and viral load data.