NEUROLOGIC DISORDERS ASSOCIATED WITH HIV/AIDS

RAFAEL KANJI NAKAMURA, ELEXANDRA APARECIDA SIMÕES, GISELI KARENINA TRAESEL, LETÍCIA MIE MORIYA, LUIS EDUARDO SILVA ORMONDE, MAIRA THAÍS HARO ROSSINI

Resumo


Introduction: First diagnosed in the 80s the Acquired Immune Deficiency Syndrome (AIDS) has become a
pandemic challenge to public health. AIDS is caused by HIV-1 and HIV-2 (Human Immunodeficiency Virus)
and has as hallmark progressive fall of T-cells CD4+ leading to profound immunosuppression that
predisposes the patient to opportunistic infections and neoplastic diseases1,12. HIV is most likely to infect
the immune system but it can also reach the Central Nervous System (CNS)12. Therefore, the relevance of
this study consists in to identify the neurologic disorders associated with the HIV infection and their
impacts on the quality of patients’ lives and to highlight the need of more researches in this area.
Objective: To present concepts and discussion about neurologic disorders associated with HIV/AIDS
infection. Material and methods: This study was based in published articles in the database of Medline,
PubMed and Scielo in English and Portuguese languages that discussed about HIV and neurologic
disorders. Results: A study made with 653 HIV-infected patients indicated that 26% showed symptoms
related to neurological disturbs. The main neurological symptoms were motor deficit, headache, mental
confusion, convulsive crises, behavior changing and memory disturb. 5 Another study involving 1.651 HIVinfected patients, presented 24,5% with at least one neurologic disorder, whereas 41% patients with AIDS
presented neurologic disorders associated13. Discussion: HIV - associated neurocognitive disorders
(HAND) have many clinical manifestations, since the asymptomatic form until serious cognitive changes,
as the dementia. Its pathogenesis starts with the virus infection in the cerebral parenchyma through
infected monocytes that cross the blood-brain barrier (“Trojan horse”).2,3,7 Consequently, there will be
the immune system activation, occasioning the neuroinflammation that will predispose to
neurodegeneration2,8. For the HAND development is necessary the interaction between viral and host
factors. Factors related to the host include genetic predisposition, metabolic disorders (insulin resistance),
aging, vascular disease, anaemia, malnutrition, hepatitis C virus infection and patient behavioral habits
(use of psychoactive substances like cocaine, for example) which can potentialize the infection2,3,9. On the
other hand, HIV associated factors are AIDS, immune system activation, HIV subtypes, neuro-adaptation
and resistance to drugs2,10. HAND is a subdiagnosed problem in HIV+ population. Several tests are
available in the clinical practice in order to evaluate cognitive function, some of them are simple and quick,
like MOS-HIV and PAOFI2. Despite the therapy progress there isn't enough research to prove the best
therapeutic approach, although antiretroviral drugs and combination therapy with high CPE (Central
Nervous System Penetration-effectiveness Score) drugs must be considered, while pharmacological
therapies and other alternatives are being studied2,3,4. Conclusion: It is crucial to the well-being of the
patient in treatment of HIV the precise and early diagnosis of neurologic complications, besides a
therapeutic intervention capable of relieving the symptoms and promote quality of life.

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Referências


Brasil. Ministério da Saúde. Departamento de DST, Aids e Hepatites Virais. Available at:

http://www.aids.gov.br/pagina/aids-no-brasil

Elbirt D, Mahlab-Guri K, Bezalel-Rosenberg S, Gill H, Attali M and Asher I. HIV-Associated

Neurocognitive Disorders (HAND). IMAJ, 17, January 2015.

Gannon P, Khan M, Kolson D. Current understanding of HIV- associated neurocognitive disorders

pathogenesis. Curr Opin Neurol; 24(3): 275–283. June 2011.

Tedaldi E, Minniti N, Fischer T. HIV-Associated Neurocognitive Disorders: The Relationship of HIV

Infection with Physical and Social Comorbidities. BioMed Research International, 1-16. January 2015.

Puccioni-Sohler M, Corrêa RB, Perez MA, Schechter M, Ramos Filho C, Novis SAP. Complicações

Neurológicas da Síndrome de Imunodeficiência Adquirida. Arq. Neuro-Psiquiatr. 1991 June; 49(2): 159-

Kaul M. HIV-1 associated dementia: update on pathological mechanisms and therapeutic

approaches. Curr Opin Neurol 2009; 22: 315-20.

Lindl KA, Marks DR, Kolson DL, Jordan-Sciutto KL. HIV-associated neurocognitive disorder:

pathogenesis and therapeutic opportunities. J Neuroimmune Pharmacol 2010; 5: 294-309.

González-Scarano F, Martín-García J. The neuropathogenesis of AIDS. Nat Rev Immunol 2005; 5:

-81.

Gonzalez E, Rovin BH, Sen L, et al. HIV-1 infection and AIDS dementia are influenced by a mutant

MCP-1 allele linked to increased monocyte infiltration of tissues and MCP-1 levels. Proc Natl Acad Sci USA

; 99: 13795-800.

Ellis RJ, Badiee J, Vaida F, et al. CD4 nadir is a predictor of HIV neurocognitive impairment in the

era of combination antiretroviral therapy. AIDS 2011; 25:1747-51.

Robbins & Cotran et. al. Patologia: Bases patológicas das doenças. Elsevier. 8ª ed. 2012.

Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Medicina Interna de Harrison.

ª ed. Porto Alegre: AMGH, 2013.

Vivithanaporn P, Heo G, Gamble J et al. Neurologic disease burden in treated HIV/AIDS predicts

survival. Neurology 75; 1150-1158. September 2010.


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