ArticleResearch square2026
Distinct acute and chronic brain health phenotypes among people living with HIV in a Ugandan clinical cohort: a comorbidity network analysis.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Individual brain health conditions among people living with HIV in sub-Saharan Africa are increasingly well documented, but the co-occurrence of comorbidity and multimorbidity across distinct neurological and psychiatric conditions remains poorly characterized in this setting. We examined the co-occurrence structure of brain health conditions in a specialist HIV clinical cohort in Uganda. Methods: We analyzed 1,137 ICD-10-coded records from 581 patients in a specialist HIV neuropsychiatric cohort in Kampala (2017 to April 2026). All ICD-10 codes were classified, based on expert clinical consultation, into eight brain health domains and a two-level phenotype (acute versus chronic). Pairwise cooccurrence among domains with at least ten patients was tested using phi coefficients with bootstrap confidence intervals and Benjamini-Hochberg correction; latent class analysis was a pre-specified sensitivity analysis. Results: Of 573 classifiable patients, 476 (83.1%) carried a single brain health domain and only 12 (2.1%) carried diagnoses from both the acute and chronic phenotypes. Depression, bipolar and psychosis spectra co-aggregated (phi 0.11 to 0.25), while opportunistic CNS infection was mutually exclusive with every chronic domain (phi as low as -0.734). Cognitive impairment showed no significant association with major depressive disorder (12 patients with both domains; phi - 0.064, q = 0.203). Latent class analysis independently recovered a multimorbid chronic phenotype (24.6% of patients). Conclusions: Brain health conditions in this cohort partition into two clearly separated phenotypes: an acute opportunistic-infection phenotype and a chronic phenotype in which depressive, bipolar and psychotic presentations co-aggregate. Cognitive impairment and major depressive disorder, a comorbidity widely assumed to be common in HIV, showed no significant association in this cohort. Precise, clinically grounded classification of ICD-10 diagnoses is important for valid comorbidity research in HIV neuropsychiatry.
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