ABSTRACT
Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.
Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Aged , Aged, 80 and over , Young Adult , HIV Seropositivity/epidemiology , Neurocognitive Disorders/epidemiology , Neurocognitive Disorders/virology , Depression/epidemiology , Depression/virology , Brain/virology , Brazil/epidemiology , Cross-Sectional Studies , Risk Factors , AIDS Dementia Complex/complications , AIDS Dementia Complex/psychology , AIDS Dementia Complex/epidemiology , HIV Seropositivity/psychology , CD4 Lymphocyte Count , Viral Load , Neurocognitive Disorders/diagnosis , Educational Status , Neuropsychological TestsABSTRACT
Combined antiretroviral therapy has enabled human immunodeficiency virus (HIV) carriers to live longer. This increased life expectancy is associated with the occurrence of degenerative diseases, including HIV-associated neurocognitive disorders (HAND), which are diagnosed via a complex neuropsychological assessment. The International HIV Dementia Scale (IHDS) is a screening instrument validated in Brazil for use in the absence of neuropsychological evaluation. HIV patients are frequently diagnosed with depression. We aimed to determine the prevalence of neurocognitive impairment using the IHDS and depressive disorders using the Hamilton Rating Scale for Depression (HAM-D17), compare the IHDS performance with the performances on the Timed Gait Test (TGT), the Digit Symbol Coding Test (DS) and the Brazilian version of the Scale of Instrumental Activities of Daily Living (IADL), and evaluate the association between the IHDS performance and clinical-demographic variables.
One hundred fourteen patients were evaluated in a cross-sectional study conducted in a public outpatient clinic for infectious diseases in Marília City, State of São Paulo, Brazil. Data were collected following consultation. Statistical analysis was performed in accordance with the nature and distribution of the data and hypotheses.
According to the IHDS, 53.2% of the sampled patients were neuropsychologically impaired. According to the HAM-D17, 26.3% had depressive disorders. There were significant associations between the IHDS and the TGT and DS. Multiple regression analysis indicated that female gender, educational level, and cluster of differentiation 4 (CD4) levels were significantly and independently associated with neurocognitive impairment.
The prevalence of neurocognitive impairment ...
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , AIDS Dementia Complex/epidemiology , Depression/epidemiology , AIDS Dementia Complex/psychology , Brazil/epidemiology , Cross-Sectional Studies , Depression/diagnosis , Depression/etiology , Educational Status , Neuropsychological Tests , Prevalence , Psychiatric Status Rating Scales , Risk FactorsABSTRACT
Se presenta el informe de cuatro casos psiquiátricos relacionados con el SIDA en Honduras donde, hasta abril de 1993 se han reportado 2.544casos. Sólo en la ciudad de San Pedro Sula, se han reportado 1.000 casos -. Se Sugieren medidas para la mejor atención psiquiátrica y psicológica de los enfermos (tanto los eropositivos como los portadores sanos): en unos, para suavizar el tránsito hacia la muerte; en los otros, para tratar de reducir la discriminación social de la que son objeto
Subject(s)
Humans , Male , Female , Adult , Acquired Immunodeficiency Syndrome/psychology , AIDS Dementia Complex/psychology , AIDS Dementia Complex/therapy , Follow-Up Studies , Neurologic Manifestations , Acquired Immunodeficiency Syndrome/therapyABSTRACT
The progressive confirmation of the neurotropic character of HIV, in juxtaposition to the recognition of AIDS dementia complex as an important central nervous system clinical manifestation, have engendered a greater interest in this phenomena. Consequently, a more precise description of the behavioral and mental aspects of this infection have evolved. This article has two purposes, to discuss the AIDS dementia complex concept and secondly, to review the neuropsychiatric and neuropsychological aspects of infection by HIV and AIDS, as it pertains to adult patients
Subject(s)
Humans , AIDS Dementia Complex/psychology , Central Nervous System Diseases/etiology , HIV Infections/complications , Electrophysiology/methods , HIV Seropositivity/psychology , Opportunistic Infections/complications , HIV Infections/psychology , Neurocognitive Disorders/etiology , Neuropsychological TestsABSTRACT
A infecção pelo HIVð1, o agente causador da SIDA (Síndrome de Imunodeficiência Adquirida), se associa com impressionante freqüência a quadros neurológicos e neuropsiquiátricos. Tais quadros podem ser devidos a neoplasias e infecções mas também pelo próprio vírus, que é neurotrópico. O comprometimento do SNC parece ser bastante precoce e leva a alterações patológicas bastante características: as células multinuceadas, os nódulos microgliais, desmielinização e astrocitose. O quadro mais comum é a demência de instalação insidiosa, geralmente nas fases mais avançadas porém podendo ocorrer sem qualquer sintomatologia sistêmica também (indivíduos soropositivos assintomáticos). Os quadros psicóticos e afetivos também são encontradiços nestes pacientes