RESUMO
HIV infection is an important medical and social problem. In Poland, similarly to other countries, patients with HIV infections are mostly young people. Apart from typical immunologic pathologies, the HIV infection leads to some neurocognitive, motoric and behavioral disorders. The aim of this paper is to present the up-to-date knowledge of HIV-associated neurocognitive disorders (HAND).
Assuntos
Viroses do Sistema Nervoso Central/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Saúde Mental/estatística & dados numéricos , Adolescente , Fármacos Anti-HIV/uso terapêutico , Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Infecções Bacterianas do Sistema Nervoso Central/virologia , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Infecções Fúngicas do Sistema Nervoso Central/virologia , Infecções Parasitárias do Sistema Nervoso Central/epidemiologia , Infecções Parasitárias do Sistema Nervoso Central/virologia , Viroses do Sistema Nervoso Central/tratamento farmacológico , Viroses do Sistema Nervoso Central/virologia , Comorbidade , Feminino , Nível de Saúde , Humanos , Masculino , Testes Neuropsicológicos , Polônia/epidemiologia , Adulto JovemRESUMO
PURPOSE OF REVIEW: Neurologic complications of HIV infection are unfortunately common, even in the era of effective antiretroviral treatment (ART). The consulting neurologist is often asked to distinguish among neurologic deterioration due to opportunistic infection (OI), immune reconstitution, or the effect of the virus itself, and to comment on the role of immunomodulatory agents in patients with HIV infection. Additionally, as successful virologic control has extended the life span of patients with HIV infection, neurologists are called upon to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy. RECENT FINDINGS: Despite the use of ART, significant numbers of patients continue to be affected by HIV-associated neurocognitive disorders, although with milder forms compared to the pre-ART era. Regimens of ART have been ranked according to CNS penetration and are being studied with regard to neuropsychological outcomes. Nucleoside analogs with the greatest potential for peripheral neurotoxicity are no longer considered first-line agents for HIV treatment. Efavirenz, a non-nucleoside reverse transcriptase inhibitor, has the greatest frequency of neurologic side effects among newer ART regimens. The spectrum of clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) continues to grow, including IRIS without underlying OI. A greater understanding of pathophysiology and risk factors has shown that while HIV should be treated early to prevent severe immunocompromise, delayed initiation of ART may be helpful while treating OIs. SUMMARY: This article reviews the neurologic complications of HIV infection, or its treatment, most commonly encountered by neurologists.
