Depression and diagnosis of neurocognitive impairment in HIV-positive patients

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.

Prevalence of neurocognitive disorders and depression in a Brazilian HIV population

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.

Aspectos psiquiátricos y sociales del SIDA: informe de cuatro casos / Psychiatric and social aspects of AIDS: report of 4 cases

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

Infección por VIH y SIDA: aspectos neuropsiquiátricos y Neuropsicológicos / HIV infection and AIDS: neuropsychiatric and neuropsychological aspects

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

Os distúrbios mentais orgânicos e a síndrome de imunodeficiência adquirida (SIDA) - Parte I / The organic mental disturbances and acquired immune deficiency syndrome (AIDS) - Part I

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