ABSTRACT
El Virus de Inmunodeficiencia Humana (VIH) tiene un carácter neurotrópico, es decir afecta tanto el sistema inmunológico como el sistema nervioso de los pacientes, generando déficits conocidos como trastorno neurocognitivo asociado con el VIH (HAND por sus siglas en inglés). Los HAND se evidencian en el deterioro de las funciones ejecutivas y las funciones cognitivas de los pacientes y pueden ser clasificados en tres tipos: 1. Deterioro neurocognitivo asintomático asociado con el VIH, 2. Trastorno neurocognitivo leve asociado con el VIH, y 3. Demencia asociada al VIH. Los HAND tienen efectos perjudiciales en la calidad de vida y en las actividades cotidianas de los pacientes, pues intervienen en el rendimiento de tareas laborales, la adherencia al tratamiento o ingesta de medicamentos, conducción de vehículos y continuidad de la independencia. Para detener o prevenir la aparición de un HAND se ha estudiado la terapia antiretroviral, sin embargo, esta acción no es definitiva, por ello deben tomarse medidas adicionales como intervenciones psicológicas y neuropsicológicas pertinentes. En muchos casos la agudeza de los trastornos neurocognitivos dificulta su identificación, siendo la detección temprana de déficits en las diferentes habilidades cognitivas un factor esencial en el diagnóstico del VIH, pues al ser una afección crónica se puede esperar un mayor deterioro a futuro en caso de no ser intervenido.(AU)
The Human Immunodeficiency Virus (HIV) has a neurotropic character, so it affects both the immune system and the nervous system of the patients, producing deficits known as HIV associated neurocognitive disorder (HAND). HANDs are evidenced with the deterioration of executive and cognitive functions, and can be classified into three types: 1. Asymptomatic neurocognitive impairment associated with HIV, 2. Mild neurocognitive disorder associated with HIV and 3. HIV associated dementia. HANDs have detrimental effects on the quality of life and the daily activities of the patient, as they interfere in work performance, adherence to treatment or ingestion of drugs, operation of vehicles and continuity of independence. To stop or prevent the onset of a HAND, antiretroviral therapy has been studied, however, this action is not definitive, therefore additional measures as timely psychological and neuropsychological interventions should be taken. In many cases, the acuity of neurocognitive disorders makes identification difficult. Early detection of cognitive deficits is an essential factor in the diagnosis of HIV, because it is a chronic condition, further deterioration can be expected in the future if intervention is not applied on time. regarding endothelial glycocalyx damage and ischemia-reperfusion injury.(AU)
Subject(s)
Humans , Male , Female , HIV , HIV/pathogenicity , Neurocognitive Disorders/virology , Treatment Adherence and Compliance , Quality of Life , Activities of Daily Living , Executive Function , Work Performance , Nervous SystemABSTRACT
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.