RESUMO
Dementia interferes with the individual's motor, behavioural, and intellectual functions, causing him to be unable to perform instrumental activities of daily living. This study is aimed at identifying the best performing algorithm and the most relevant characteristics to categorise individuals with HIV/AIDS at high risk of dementia from the application of data mining. Principal component analysis (PCA) algorithm was used and tested comparatively between the following machine learning algorithms: logistic regression, decision tree, neural network, KNN, and random forest. The database used for this study was built from the data collection of 270 individuals infected with HIV/AIDS and followed up at the outpatient clinic of a reference hospital for infectious and parasitic diseases in the State of Ceará, Brazil, from January to April 2019. Also, the performance of the algorithms was analysed for the 104 characteristics available in the database; then, with the reduction of dimensionality, there was an improvement in the quality of the machine learning algorithms and identified that during the tests, even losing about 30% of the variation. Besides, when considering only 23 characteristics, the precision of the algorithms was 86% in random forest, 56% logistic regression, 68% decision tree, 60% KNN, and 59% neural network. The random forest algorithm proved to be more effective than the others, obtaining 84% precision and 86% accuracy.
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Complexo AIDS Demência/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicações , Algoritmos , Demência/etiologia , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/etiologia , Idoso , Brasil/epidemiologia , Biologia Computacional , Mineração de Dados/métodos , Mineração de Dados/estatística & dados numéricos , Bases de Dados Factuais , Árvores de Decisões , Feminino , Seguimentos , Humanos , Modelos Logísticos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Fatores de RiscoRESUMO
The population of aging adults living with human immunodeficiency virus (HIV) is growing worldwide and evidence suggests that frailty occurs prematurely among them. In turn, frailty has been associated with cognitive decline. It is unknown, however, if people with both frailty and HIV infection have a higher risk of cognitive impairment compared with nonfrail HIV-infected persons. Therefore, the main objective of this study was to determine the association between the phenotype of frailty and HIV-associated neurocognitive disorders (HAND) among adults aged 50 years or older living with HIV/AIDS. A cross-sectional study was conducted on 206 adults living with HIV receiving care in a university-affiliated tertiary care hospital in Mexico City. Frailty was defined as per the Fried criteria. The presence of HAND was established according to the Antinori criteria: HIV-associated asymptomatic neurocognitive impairment (ANI), HIV-associated mild neurocognitive disorder (MND), or cognitively nonimpaired. Multinomial logistic regression models were used to test the independent association between frailty and HAND adjusting for potential confounders. Mean age of participants was 60.5 ± 6.3 years and 84.9% were male. Prevalence of HAND and frailty phenotype was 66.0% and 2.9%, respectively. The unadjusted analysis showed that both prefrail and frail statuses were associated with MND but not with ANI. However, after adjustment, the association with MND remained significant only among prefrail participants and no longer for frail persons (risk ratio [RR] = 5.7, 95% confidence intervals [CI] 1.09-29.82; p = .039 and RR = 18.3, 95% CI 0.93-362.6; p = .056, respectively). Prefrailty is associated with symptomatic neurocognitive disorders in older adults living with HIV. The spectrum of the frailty phenotype in this already vulnerable population should serve as an indicator of concomitant cognitive decline.
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Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/patologia , Fragilidade/complicações , Fragilidade/patologia , Infecções por HIV/complicações , Infecções por HIV/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , PrevalênciaRESUMO
HIV-associated neurocognitive disorders (HAND) remain frequent even among individuals receiving combined antiretroviral therapy (cART). In addition, HAND may adversely affect the quality of life and adherence to cART. There is scarce epidemiological information about HAND in Latin America. This cross-sectional study recruited HIV-infected patients from a tertiary teaching institution in São Paulo, Brazil, between May 2013 and February 2015. The patients were adults with at least 4 years of education and patients with current neurological or psychiatric diseases were excluded. HAND remain frequent even among individuals receiving cART, use of psychoactive substance, or inability to understand the content for neuropsychological evaluation. We used standardized tools to evaluate depression, use of psychoactive substances, and daily life activities, and we performed a comprehensive neuropsychological examination. HAND was classified using the Frascati criteria. Prevalence of HAND was estimated, and an associated variable of symptomatic HAND was identified by logistic regression. Four-hundred twelve HIV-infected patients were included [male: 281 (68%), mean age of 45.3 years]. Most of them [n = 340 (83.7%)] had an undetectable viral load. The prevalence of HAND was 73.6% (n = 303): 210 (50.9%) had asymptomatic neurocognitive involvement (ANI), 67 (16.2%) had mild neurocognitive disorder (MND), and 26 (6.3%) had HIV-associated dementia (HAD). The univariate logistic regression analysis showed that female gender, age older than 50 years, <11 years of schooling, CD4 count below 200 cells/mm3, presence of previous illnesses (e.g., diabetes, hypertension), opportunistic disease history, and a Beck Depression Inventory (BDI) score between 13 and 19 points were factors associated with symptomatic HAND (MND and HAD). However, a BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND. HAND was highly prevalent in São Paulo, Brazil, and ANI was the more frequent category of HAND. However, 22.5% of participants had symptomatic HAND. This finding constitutes a challenge in clinical practice. A BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND.
Assuntos
Complexo AIDS Demência/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/diagnóstico , Depressão/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/psicologia , Testes Neuropsicológicos/estatística & dados numéricos , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/psicologia , Atividades Cotidianas , Adulto , Idoso , Antirretrovirais/uso terapêutico , Brasil/epidemiologia , Contagem de Linfócito CD4 , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Escolaridade , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Carga ViralAssuntos
Terapia Antirretroviral de Alta Atividade/métodos , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/psicologia , Terapia Antirretroviral de Alta Atividade/tendências , Disfunção Cognitiva/psicologia , Feminino , Infecções por HIV/psicologia , Humanos , Estados Unidos/epidemiologia , Carga Viral/efeitos dos fármacos , Carga Viral/métodos , Carga Viral/tendênciasRESUMO
BACKGROUND: Prevalence estimates of HIV-associated neurocognitive disorders (HAND) may be inflated. Estimates are determined via cohort studies in which participants may apply suboptimal effort on neurocognitive testing, thereby inflating estimates. Additionally, fluctuating HAND severity over time may be related to inconsistent effort. To address these hypotheses, we characterized effort in the Multicenter AIDS Cohort Study. METHODS: After neurocognitive testing, 935 participants (525 HIV- and 410 HIV+) completed the visual analog effort scale (VAES), rating their effort from 0% to 100%. Those with <100% then indicated the reason(s) for suboptimal effort. K-means cluster analysis established 3 groups: high (mean = 97%), moderate (79%), and low effort (51%). Rates of HAND and other characteristics were compared between the groups. Linear regression examined the predictors of VAES score. Data from 57 participants who completed the VAES at 2 visits were analyzed to characterize the longitudinal relationship between effort and HAND severity. RESULTS: Fifty-two percent of participants reported suboptimal effort (<100%), with no difference between serostatus groups. Common reasons included "tired" (43%) and "distracted" (36%). The lowest effort group had greater asymptomatic neurocognitive impairment and minor neurocognitive disorder diagnosis (25% and 33%) as compared with the moderate (23% and 15%) and the high (12% and 9%) effort groups. Predictors of suboptimal effort were self-reported memory impairment, African American race, and cocaine use. Change in effort between baseline and follow-up correlated with change in HAND severity. CONCLUSIONS: Suboptimal effort seems to inflate estimated HAND prevalence and explain fluctuation of severity over time. A simple modification of study protocols to optimize effort is indicated by the results.
Assuntos
Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/psicologia , Infecções por HIV/complicações , Infecções por HIV/psicologia , Testes Neuropsicológicos , Autorrelato , Complexo AIDS Demência/epidemiologia , Bissexualidade , Análise por Conglomerados , Etnicidade , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina , Humanos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Transtornos da Memória/complicações , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
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.
Assuntos
Depressão/epidemiologia , Depressão/virologia , Soropositividade para HIV/epidemiologia , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/virologia , Complexo AIDS Demência/complicações , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/virologia , Brasil/epidemiologia , Contagem de Linfócito CD4 , Estudos Transversais , Escolaridade , Feminino , Soropositividade para HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/diagnóstico , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco , Inquéritos e Questionários , Carga Viral , Adulto JovemRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Soropositividade para HIV/epidemiologia , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/virologia , Depressão/epidemiologia , Depressão/virologia , Encéfalo/virologia , Brasil/epidemiologia , Estudos Transversais , Fatores de Risco , Complexo AIDS Demência/complicações , Complexo AIDS Demência/psicologia , Complexo AIDS Demência/epidemiologia , Soropositividade para HIV/psicologia , Contagem de Linfócito CD4 , Carga Viral , Transtornos Neurocognitivos/diagnóstico , Escolaridade , Testes NeuropsicológicosRESUMO
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The prevalence of neurocognitive impairment according to the IHDS is high and associated with female gender, education level, and low CD4 levels.
Assuntos
Complexo AIDS Demência/epidemiologia , Depressão/epidemiologia , Complexo AIDS Demência/psicologia , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Adulto JovemRESUMO
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 ...
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Complexo AIDS Demência/epidemiologia , Depressão/epidemiologia , Complexo AIDS Demência/psicologia , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Escolaridade , Testes Neuropsicológicos , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de RiscoRESUMO
OBJECTIVES: We aimed to characterize neurological outcomes and determine the prevalence of HIV encephalopathy in a cohort of HIV-infected children in Jamaica. METHODS: Data for 287 HIV-infected children presenting between 2002 and 2008 were reviewed and neurological outcomes characterized. A nested case-control study was conducted between July and September 2009 used 15 randomly selected encephalopathic HIV-infected children aged 7-10 years and 15 matched controls (non-encephalopathic HIV-infected). Their neurocognitive functions were evaluated using clinical assessment and standardized tests for intelligence, short term memory (visuo-spatial and auditory), selective attention, and fine motor and coordination functions. Outcomes were compared using Fisher's exact test and the Mann-Whitney U-test. RESULTS: Sixty-seven (23.3%) children were encephalopathic. The median age at diagnosis of HIV encephalopathy was 1.6 years (interquartile range (IQR) 1.1-3.4 years). Predominant abnormalities were delayed milestones (59, 88.1%), hyperreflexia (59, 86.5%), spasticity (50, 74.6%), microcephaly (42, 61.7%), and quadriparesis (21, 31.3%). The median age of tested children was 8.7 years (IQR 7.6-10.8 years) in the encephalopathic group and 9 years (IQR 7.4-10.7 years) in the non-encephalopathic group. Encephalopathic children performed worse in all domains of neurocognitive function (p<0.05). CONCLUSIONS: A high prevalence of HIV encephalopathy was noted, and significant neurocognitive dysfunction identified in encephalopathic children. Optimized management through the early identification of neurological impairment and implementation of appropriate interventions is recommended to improve quality of life.
Assuntos
Complexo AIDS Demência/psicologia , Transtornos Cognitivos/virologia , Países em Desenvolvimento , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Estudos de Casos e Controles , Criança , Pré-Escolar , Transtornos Cognitivos/epidemiologia , Humanos , Lactente , Jamaica/epidemiologia , Deficiências da Aprendizagem/epidemiologia , Deficiências da Aprendizagem/virologia , Transtornos da Memória/epidemiologia , Transtornos da Memória/virologia , Microcefalia/epidemiologia , Microcefalia/virologia , Prevalência , Qualidade de Vida , Reflexo AnormalRESUMO
OBJECTIVE: The aim of this study was to identify the main neurological conditions associated with HIV/AIDS in Mexican patients treated at the National Institute of Neurology and Neurosurgery (NINN) in Mexico city, the main referral center for patients with disorders of the central and peripheral nervous system. METHODS: An observational, transversal and descriptive analysis was performed. We reviewed the databases from the Department of Epidemiology and the medical records of patients with AIDS seen during the period from January 1st, 1995 to December 31, 2009. RESULTS: 320 patients were detected, the main conditions related to HIV/AIDS were brain toxoplasmosis (42%), cerebral criptoccocosis (28%), tuberculous meningitis (8.7%), linfoma no Hodking (3.75%), acute HIV infection (3.4%) and AIDS dementia complex (3%). No specific trend on morbility and mortality were detected during the period of study. CONCLUSIONS: In Mexico the most common neurological complications of HIV/AIDS are opportunistic infections.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Complexo AIDS Demência/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida , Adolescente , Adulto , Idoso , Biópsia , Doenças dos Nervos Cranianos/epidemiologia , Doenças dos Nervos Cranianos/etiologia , Escolaridade , Emprego , Feminino , Infecções por HIV/mortalidade , Humanos , Imageamento por Ressonância Magnética , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/epidemiologia , Doenças do Sistema Nervoso Periférico/etiologia , Fatores Sexuais , Fatores Socioeconômicos , Tomografia Computadorizada por Raios X , Toxoplasmose Cerebral/epidemiologia , Toxoplasmose Cerebral/etiologia , Adulto JovemRESUMO
OBJECTIVE: HIV-1-associated neurocognitive disorders (HAND) is triggered by immune activation of brain cells and remain prevalent during progressive viral infection despite antiretroviral therapy. Cathepsins and cystatins are lysosomal proteins secreted by macrophages and microglia, and may play important roles in neuroregulatory responses. Our laboratory has shown increased secretion and neurotoxicity of cathepsin B from in-vitro HIV-infected monocyte-derived macrophages, and increased expression in postmortem brain tissue with HIV encephalitis and HAND. We hypothesized that cystatin B and cathepsin B could represent potential biomarkers for HAND. METHODS: Monocytes, plasma, and cerebrospinal fluid (CSF) from retrospective samples from 63 HIV-seropositive Hispanic women were selected for this study. These were stratified as 27 normal, 14 asymptomatic, and 22 HIV dementia, and as 14 progressors and 17 nonprogressors. Samples were evaluated for cystatins B and C and cathepsin B expression and activity. RESULTS: Increased cathepsin B and cystatins B and C were found in plasma of HIV-seropositive women. Higher intracellular expression of cathepsin B and cystatin B were found in monocytes from women with HIV-associated dementia (P < 0.05). Significant increase in cystatin B concentration in CSF was found in women with dementia compared with HIV-seropositive asymptomatic women. CONCLUSION: These results demonstrate that dysregulation of cystatin B-cathepsin B system is operative in HIV-associated neurocognitive impairment and suggests that intracellular expression of cystatin B and cathepsin B in monocytes could be potential candidate biomarkers for HIV dementia, whereas increased cathepsin B and cystatins B and C in plasma are potential candidate markers of chronic HIV-1 activation.
Assuntos
Complexo AIDS Demência/metabolismo , Catepsina B , Cistatina B , Soropositividade para HIV/metabolismo , HIV-1/metabolismo , Hispânico ou Latino/estatística & dados numéricos , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/fisiopatologia , Adulto , Biomarcadores/metabolismo , Barreira Hematoencefálica/metabolismo , Catepsina B/metabolismo , Cistatina B/metabolismo , Progressão da Doença , Feminino , Citometria de Fluxo , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/fisiopatologia , Humanos , Estudos Longitudinais , Monócitos/metabolismo , Testes Neuropsicológicos , Estados Unidos/epidemiologia , Regulação para Cima , Carga ViralRESUMO
BACKGROUND: The study was undertaken to describe the frequency of HIV-associated neurocognitive disorders (HAND) and depressive symptoms in an older population with human immunodeficiency virus (HIV). METHODS: A cross-sectional analysis of patients aged 50 years or older infected with HIV was carried out in an outpatient setting in Brazil from March to November 2008. Patients selected were submitted to cognitive evaluation using the Mini-Mental State Examination and International HIV Dementia Scale, and also to functional and depression evaluations. RESULTS: Among the 52 patients evaluated, the frequency of neurocognitive disorder was 36.5%, while for dementia the frequency was 13.5%. No risk factors were identified. Among the patients with cognitive impairment, 73.7% had cortical impairment. The frequency of depressive symptoms was of 34.6%. The female gender was identified as a risk factor (p = 0.018) and patients with depressive symptoms had greater functional impairment (p < 0.001). CONCLUSION: HAND and depressive symptoms are common in an older population. Patients with cognitive impairment achieved lower scores on the cortical assessment scales. Depressive symptoms are a stronger factor for functional impairment.
Assuntos
Complexo AIDS Demência/epidemiologia , Depressão/etiologia , Infecções por HIV/psicologia , Complexo AIDS Demência/etiologia , Complexo AIDS Demência/psicologia , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Sexuais , Estatísticas não ParamétricasRESUMO
Toxoplasmosis, a protozoan disease, causes severe disease in fetuses during pregnancy and deadly encephalitis in HIV patients. There are several studies on its seroprevalence around the world, but studies focusing on African countries are limited in number and mostly anecdotal. We studied two groups of samples from Mozambique by ELISA, using serum samples from 150 pregnant women and six Cerebrospinal fluid (CSF) samples from AIDS patients with encephalitis. HIV status was confirmed, and CD4 blood counts were obtained from HIV-positive pregnant women. IgG seroprevalence of the group as a whole was 18.7 percent (28/150), with a higher prevalence in HIV-positive individuals compared to those who were HIV-negative (31.3 percent, [18/58] vs. 10.9 percent, [10/92]) patients. These data may be biased due to cumulative effects of exposition affecting disease prevalence. If corrected, this data may indicate an interaction of HIV and T. gondii. Prevalence of both diseases increases with age, but this is more clearly seen for toxoplasmosis (p < 0.005) than HIV infection, possibly explained by higher transmission of HIV after childhood. In HIV patients suffering from encephalitis, CSF serology showed that 33 percent of specific IgG CSF had a high avidity, which was in accordance with the data from the group of pregnant women. Lower prevalence rates of both infections in older groups could be explained by more deaths in the infected groups, resulting in an artificially lower prevalence. Using CD4 counts as a marker of time of HIV infection, and correcting for age, patients with contact with T. gondii had fewer CD4 cells, suggesting prolonged HIV disease or other causes. Toxoplasma IgG prevalence is higher in HIV+ groups, which could be ascribed to HIV- and T. gondii-associated risk factors, such as exposure to higher and more diverse social contacts. The low incidence of Toxoplasma IgG in younger age groups shows that transmission could be related to better access to cyst-containing meat in adulthood, as environmental transmission due to oocysts is usually blamed for higher incidence in children. Taken together, these data support the urgent need of research in toxoplasmosis in Africa, especially in the presence of HIV epidemics.
Toxoplasmose, uma protozoonose, causa doença grave em fetos de mulheres grávidas com infecção aguda e encefalite letal em portadores de HIV. Apesar de muitos estudos sobre sua prevalência no Mundo, existem apenas alguns relatos da toxoplasmose na África Austral, geralmente anedóticos. Estudamos por ELISA dois grupos de amostras de Moçambique, usando 150 amostras de soros de mulheres grávidas e seis amostras de Liquido Cefalorraquidiano (LCR) de pacientes com AIDS e encefalite. O estado da infecção pelo HIV foi confirmado e a contagem de células CD4+ no sangue foi obtida das pacientes grávidas infectadas pelo HIV. No grupo das gestantes, IgG anti T.gondii foi encontrada em 18.7 por cento (28/150), mais freqüente em pacientes HIV positivas (31.3 por cento, 18/58) do que em HIV negativas (10.9 por cento, 10/92). A ocorrência de ambas as doenças aumenta com a idade, mais claramente vista na toxoplasmose (p < 0.005) do que na infecção pelo HIV, devido maior transmissão do HIV após a infância. Na encefalite em pacientes HIV+, a sorologia do LCR mostrou uma ocorrência de 33 por cento de IgG especifica de alta avidez, que está de acordo com a ocorrência neste grupo etário, baseado nos dados de nossas gestantes. A menor ocorrência de ambas as infecções em grupos etários mais idosos pode ser explicada pela mortalidade cumulativa por qualquer causa nos grupos mais idosos, resultando em menor ocorrência relativa. Usando as contagens de células CD4+ como marcadores da progressão da infecção pelo HIV e corrigindo para grupos etários, as gestantes HIV+ com contato com T. gondii tem menores níveis de células CD4+ do que as gestantes HIV+ sem contato com T.gondii. A ocorrência maior da toxoplasmose em gestantes HIV+ pode ser atribuída a fatores de risco semelhantes, como exposição a maior contato social. A baixa ocorrência da toxoplasmose em grupos mais jovens pode se relacionar com menor acesso a carne contendo cistos, já que a transmissão ambiental por oocistos está associada à maior incidência em crianças. Todos estes dados reforçam a necessidade de pesquisa da toxoplasmose na África Austral, especialmente na presença da epidemia pelo HIV.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Complexo AIDS Demência/epidemiologia , Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Fatores Etários , Complexo AIDS Demência/líquido cefalorraquidiano , Anticorpos Antiprotozoários/sangue , Ensaio de Imunoadsorção Enzimática , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Incidência , Imunoglobulina G/sangue , Contagem de Linfócitos , Moçambique/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco , Toxoplasma/imunologia , Toxoplasmose/complicações , Toxoplasmose/diagnósticoRESUMO
Primary neurological complications of AIDS include cognitive deficits such as HIV-associated dementia and milder forms such as cognitive/motor disorders, which cause changes in daily activities and reduce the quality of life of patients. Infection with HIV-1 is the most common, predictable and treatable cause of cognitive deficits in individuals with less than 50 years of age. Despite advances in the understanding of clinical characteristics, pathogenesis and neurobiological aspects and widespread use of highly active antiretroviral therapy (HAART), neurological complications and cognitive deficits still persist with serious personal and socioeconomic consequences, thus representing a great therapeutic challenge. In the pre-HAART era dementia was a common complication of infection whose incidence declined during the HAART era. However, prevalence of dementia has increased, especially that of milder forms due to the increased number of infected individuals and increased life expectancy. Cognitive alterations associated with HIV are typically sub cortical and can be associated with behavioral and motor disorders. These syndromes are clinically diagnosed by neuropsychological tests, while neuroimaging and analysis of cerebrospinal fluid contribute to diagnosis. This review is an update on current epidemiological status, clinical characteristics and diagnosis of cognitive complications observed during the course of HIV infection.
Assuntos
Complexo AIDS Demência , Transtornos Cognitivos , Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/virologia , HumanosRESUMO
Toxoplasmosis, a protozoan disease, causes severe disease in fetuses during pregnancy and deadly encephalitis in HIV patients. There are several studies on its seroprevalence around the world, but studies focusing on African countries are limited in number and mostly anecdotal. We studied two groups of samples from Mozambique by ELISA, using serum samples from 150 pregnant women and six Cerebrospinal fluid (CSF) samples from AIDS patients with encephalitis. HIV status was confirmed, and CD4 blood counts were obtained from HIV-positive pregnant women. IgG seroprevalence of the group as a whole was 18.7% (28/150), with a higher prevalence in HIV-positive individuals compared to those who were HIV-negative (31.3%, [18/58] vs. 10.9%, [10/92]) patients. These data may be biased due to cumulative effects of exposition affecting disease prevalence. If corrected, this data may indicate an interaction of HIV and T. gondii. Prevalence of both diseases increases with age, but this is more clearly seen for toxoplasmosis (p < 0.005) than HIV infection, possibly explained by higher transmission of HIV after childhood. In HIV patients suffering from encephalitis, CSF serology showed that 33% of specific IgG CSF had a high avidity, which was in accordance with the data from the group of pregnant women. Lower prevalence rates of both infections in older groups could be explained by more deaths in the infected groups, resulting in an artificially lower prevalence. Using CD4 counts as a marker of time of HIV infection, and correcting for age, patients with contact with T. gondii had fewer CD4 cells, suggesting prolonged HIV disease or other causes. Toxoplasma IgG prevalence is higher in HIV+ groups, which could be ascribed to HIV- and T. gondii-associated risk factors, such as exposure to higher and more diverse social contacts. The low incidence of Toxoplasma IgG in younger age groups shows that transmission could be related to better access to cyst-containing meat in adulthood, as environmental transmission due to oocysts is usually blamed for higher incidence in children. Taken together, these data support the urgent need of research in toxoplasmosis in Africa, especially in the presence of HIV epidemics.
Assuntos
Complexo AIDS Demência/epidemiologia , Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Toxoplasmose/epidemiologia , Complexo AIDS Demência/líquido cefalorraquidiano , Adolescente , Adulto , Fatores Etários , Anticorpos Antiprotozoários/sangue , Linfócitos T CD4-Positivos , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Imunoglobulina G/sangue , Incidência , Contagem de Linfócitos , Pessoa de Meia-Idade , Moçambique/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco , Toxoplasma/imunologia , Toxoplasmose/complicações , Toxoplasmose/diagnóstico , Adulto JovemRESUMO
Dentre as complicações neurológicas primária da Aids temos déficits cognitivos como a demência associada ao HIV e formas mais leves, como o transtorno cognitivo/motor menor, sendo que ambas podem alterar as atividades da vida diária e reduzir a qualidade de vida dos pacientes. Infecção pelo HIV-1 é a mais comum, previsível e tratável causa de déficits cognitivos em indivíduos com menos de 50 anos. A despeito do avanço no conhecimento das características clínicas, patogênese, aspectos neurobiológicos e ao amplo uso de terapia antirretroviral altamente ativa (HAART), complicações neurológicas e déficits cognitivos ainda persistem levando a graves consequências pessoais e socioeconômicas tornando-se um grande desafio terapêutico. Na era pré- HAART, a demência era uma complicação comum da infecção, entretanto na era HAART a incidência da demência diminuiu, mas a prevalência tem aumentado principalmente das formas mais leves devido ao aumento do número de pessoas infectadas e ao aumento da expectativa de vida. Alterações cognitivas associadas ao HIV são tipicamente subcorticais e podem estar associadas a comprometimentos comportamentais e motores. Estas síndromes são de diagnóstico clínico, sendo que testes neuropsicológicos, neuroimagem e líquido cerebrorraquidiano corroboram no diagnóstico. Esta revisão faz uma atualização do estado atual da epidemiologia, características clínicas e diagnóstico das complicações cognitivas no curso da infecção pelo HIV.
Primary neurological complications of AIDS include cognitive deficits such as HIV-associated dementia and milder forms such as cognitive/motor disorders, which cause changes in daily activities and reduce the quality of life of patients. Infection with HIV-1 is the most common, predictable and treatable cause of cognitive deficits in individuals with less than 50 years of age. . Despite advances in the understanding of clinical characteristics, pathogenesis and neurobiological aspects and widespread use of highly active antiretroviral therapy (HAART), neurological complications and cognitive deficits still persist with serious personal and socioeconomic consequences, thus representing a great therapeutic challenge. In the pre-HAART era dementia was a common complication of infection whose incidence declined during the HAART era. However, prevalence of dementia has increased, especially that of milder forms due to the increased number of infected individuals and increased life expectancy. Cognitive alterations associated with HIV are typically sub cortical and can be associated with behavioral and motor disorders. These syndromes are clinically diagnosed by neuropsychological tests, while neuroimaging and analysis of cerebrospinal fluid contribute to diagnosis. This review is an update on current epidemiological status, clinical characteristics and diagnosis of cognitive complications observed during the course of HIV infection.
Assuntos
Humanos , Complexo AIDS Demência , Transtornos Cognitivos , Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/virologiaRESUMO
HIV infection is increasing in minority groups, particularly in African American and Hispanic women. Although the incidence of HIV dementia has decreased since the advent of highly active antiretroviral treatment, prevalence of neurocognitive complications has increased as patients are now living longer. This study's purpose was to determine the psychometric properties of the Spanish-language HIV Dementia Scale (HDS) in a group of HIV-infected women. We recruited 96 women: 60 HIV-seropositive and 36 HIV-seronegative. Modification of the HDS into a Spanish-language version consisted of translating the instructions, substituting four words in Spanish (gato, media, azul, piña), increasing 1 second in the psychomotor speed because the Spanish alphabet has more letters than the English alphabet, and not offering clues for memory recall. Cognitive impairment (CI) was defined according to the modified American Academy of Neurology HIV-dementia criteria including an asymptomatic CI group. Statistical analysis consisted of analysis of variance to determine group differences and receiver operator characteristics (ROC) to determine the optimal cutoff point for the screening of CI. HDS-Spanish total score and subscores for psychomotor speed and memory recall showed significant differences between HIV-seronegative and women with HIV-dementia (p < 0.001) and between HIV-seropositive women with normal cognition and those with HIV-dementia (p < 0.001). The optimal cutoff point of 13 or less had performance characteristics of 87% sensitivity and 46% specificity for HIV-associated CI (50.0% positive predictive value, 85.0% negative predictive value). The HDS-Spanish translation offers a useful screening tool with value for the identification of Hispanic women at risk of developing HIV-associated symptomatic neurocognitive disturbances.
Assuntos
Complexo AIDS Demência/classificação , Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/epidemiologia , Adulto , Depressão/classificação , Feminino , Soronegatividade para HIV , Soropositividade para HIV , Humanos , Testes de Inteligência , Memória , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria , Desempenho Psicomotor , Porto Rico/epidemiologia , Curva ROC , Reprodutibilidade dos TestesRESUMO
La demencia asociada a infección por virus de inmunodeficiencia humana (DVIH) es una entidad caracterizada por la tríada de compromiso cognitivo, síntomas conductuales y motores, que generan serias dificultades en la capacidad funcional del paciente. Las múltiples denominaciones generan confusión y alta probabilidad de subreconocimiento. No obstante, la incidencia de DVIH es controversial; se tiene claro que más de 90 por ciento de pacientes con sida tiene anormalidades neuropatólogicas compatibles con DVIH. Los mecanismos patogénicos involucran una compleja interacción entre el VIH y las células del cerebro, que generan claramente dos vías incluyentes, la inflamatoria y la no inflamatoria, las cuales generan factores neurotóxicos y quimiotácticos, inductores de apoptosis, que conducen a una disrupción neuronal-glial, probablemente responsable de la injuria y/o muerte neuronal, que conduciría a un fenómeno de neurodegeneración acelerada. Los síntomas son de una demencia subcortical, siendo los síntomas de presentación más comunes el compromiso de la memoria, enlentecimiento mental, dificultad para la marcha y depresión. El diagnóstico es esencialmente clínico y se realiza por exclusión. Son de utilidad práctica la HIV Dementia Scale (HDS) y la internacional HIV Dementia Scale (IHDS), como pruebas iniciales de descarte. El tratamiento debe incluir la combinación de antiretrovirales y neuroprotectores. Como conclusión, la DVIH es una complicación devastadora de la infección por VIH que debe ser reconocida tempranamente.
Dementia associated to human immunodeficiency virus infection (DHIV) is an entity distinguished by three main signs -cognitive, behavioral and motor symptoms- which generate serious difficulties in the functional capacity of the patient. The multiple denominations generate confusion and diagnostic difficulties. In spite of controversy in DHIV incidence, it is clear that more than 90 per cent of patients with AIDS has compatible neuropathological anormalities with DHIV. The pathogenic mechanisms involve complex interactions between the HIV and the brain cells generating two inclusive paths, inflammatory and non inflammatory, that produce neurotoxic and chemotactic factors, inductors of apoptosis that lead to neuro-glial disruption probably responsible of injury and/or neuron cell death, that finally would lead to accelerated neurodegeneration phenomenon. Symptoms are subcortical dementia, mental sluggishness, walking difficulties and depression. Diagnosis is essentially clinical and by exclusion. The HIV Dementia Scale (HDS) and the International HIVD Scale (IHDS) are of practical usefulness as initial screening tests. Treatment should include the combination of antiretrovirals and neuroprotectors. We conclude that DHIV is a devastating complication of HIV infection that should have early recognition.
Assuntos
Humanos , Complexo AIDS Demência/diagnóstico , Complexo AIDS Demência/epidemiologia , Complexo AIDS Demência/patologia , Complexo AIDS Demência/terapia , Síndrome da Imunodeficiência AdquiridaRESUMO
INTRODUCTION: According to different authors, between 30% and 70% of children with AIDS clinically present some degree of neurological involvement. When including studies on pathology, the number increases to 96%. DEVELOPMENT: We present the epidemiology of pediatric neuro-AIDS in Argentina and our experience in the follow-up of 784 HIV+ children infected by vertical transmission, of whom 311 developed neuro-AIDS. Of these children, 92% presented encephalopathy. In 29% of cases infection of the central nervous system was the hallmark of the disease followed by recurrent bacterial infection in 33%. The present series accounts for 25% of pediatric cases of HIV infection in the country. CONCLUSIONS: In our experience, the most remarkable results of antiretroviral treatment compared with natural evolution were: a) Ad integrum remission or noteworthy improvement of progressive and non-progressive encephalopathy, b) Conversion of the most severe cases of progressive encephalopathy (severe developmental delay, acquired microcephaly, spastic quadriparesis and fatal progression) into a more moderate phenotype (less developmental delay, normal head growth, spastic paraparesis and chronic evolution of the disease), and c) Reversion of acquired microcephaly observed in the first years of the epidemic, on which little has been published in the literature.