Abstract
Objective: To determine the prevalence of patients at risk of developing HIV-associated neurocognitive disorder (HAND) and identify factors possibly associated with its occurence. Methods: Quantitative cross-sectional study conducted at the Specialized Care Service (Servico de Atendimento Especializado - SAE) for HIV/Aids of the Integrated Medical Care Center (Nucleo de Atendimento Medico Integrado - NAMI) of the University of Fortaleza (Universidade de Fortaleza - UNIFOR), Fortaleza, Ceara, Brazil. We reviewed medical records of all 249 patients that started medical follow-up at SAE/NAMI since its foundation (August/2010) until January/2014, including in the analysis those who completed the international HIV dementia scale - IHDS during routine medical visits. Epidemiological, clinical and laboratory variables were collected in addition to IHDS score and the sample was classified in two groups: patients with IHDS≥10 (Group 1) and IHDS<10 (Group 2). Chisquared test was used for categorical variables and student t test, mann whitney test and linear regression were used for numerical variables. Results: The study population consisted of 178 patients with mean IHDS score of 9.5 (+/- 1.6). HAND prevalence was 41.6% (74/178) (IHDS<10). These patients presented older mean age (37.4 years) and longer mean time from HIV diagnosis to medical follow-up than the others (10.1 months) when compared to Group 2 (31 years old and 4.6 months, respectively), suggesting that these two variables were possibly associated with HAND occurrence. Conclusion: The IHDS application showed a high prevalence of HAND in the study population. More advanced age and longer time from HIV diagnosis to medical follow-up are possibly associated with its occurence.
Highlights
The WHO estimates that almost 78 million people have been infected with HIV since the begining of this epidemic[1]
The study population consisted of 186 patients, 8 of whom were excluded due to central nervous system (CNS) infection diagnosis: 3 neurotoxoplasmosis, 2 neurosyphilis and 1 neurocryptococcosis (Figure 1)
The mean age was 34 years old - mean of 31 years old (± 9 years) for patients in group 1 and 37.4 years old (± 10 years) for those in group 2 (p
Summary
The WHO estimates that almost 78 million people have been infected with HIV since the begining of this epidemic[1]. According to the 2014 report from the Brazilian Department of STD/Aids and Viral Hepatites (Departamento de DST, Aids e Hepatites Virais – DDAHV), 734 thousand people were living with HIV/Aids (PLHA) in the country, representing a 0.4% prevalence rate[2]. Once it enters the human organism, HIV infects many immune system cells, such as CD4+ T Lymphocytes (TLCD4+) and macrophages. Some of these infected cells are located in the central nervous system (CNS) (astrocytes, microglia)(3) Clinical manifestations of this viral neurotropism are diverse since any level of the neuroaxis can be involved[4,5]. Diseases secondary to this direct invasion of HIV into the CNS are called HIV-associated neurocognitive disorders (HANDs) and can be classified as: asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia (HAD)(5)
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