Duarte Eric Andrius Coelho, Benevides Maria Luiza, Martins André Luiz Pereira, Duarte Edson Pillotto, Weller Ana Beatriz Santandrea, de Azevedo Laura Oliveira Coutinho, de Oliveira Thaís Maria Emília Rodrigues, Nunes Jean Costa
Universidade do Sul de Santa Catarina (UNISUL), Florianopolis, Santa Catarina (SC), Brazil.
Department of Neurology, Hospital Governador Celso Ramos (HGCR), Florianopolis, SC, Brazil.
Neurol Sci. 2021 May;42(5):1853-1860. doi: 10.1007/s10072-020-04705-x. Epub 2020 Sep 14.
Neurocognitive disorders remain frequent despite highly active antiretroviral treatment (HAART). The CNS is known as the sanctuary of HIV infection, where persistent neuroinflammation occurs regardless of viral suppression. Moreover, opportunistic infections, neurovascular damage and HAART neurotoxicity contribute to neurocognitive impairment. Therefore, detailed epidemiological studies might help to elucidate those complex mechanisms.
To investigate the prevalence of cognitive impairment and the associated sociodemographic, clinical and neuropsychological variables among HIV-infected patients admitted to a tertiary centre, in southern Brazil.
An observational, cross-sectional and analytic study was conducted between February 2019 and March 2020, in Hospital Nereu Ramos (HNR), with148 HIV-infected patients. They were interviewed, submitted to the International HIV Dementia Scale (IHDS) and had their medical data analysed.
The prevalence of cognitive impairment was 69.6%. It was higher among women (OR = 3.5; 95% CI 1.5-8; p < 0.01), independently of depression, educational status and age. Full years of schooling were strongly associated with IHDS scores (p < 0.01). Patient Health Questionnaire-9 (PHQ-9) scores for depression (p = 0.8), time since HIV diagnosis (p = 0.2), CD4 cell counts (p = 0.8) and viral load (p = 0.8) were not associated with IHDS scale.
A high prevalence of cognitive impairment in HIV-infected patients was identified, independently associated with the female sex and fewer years of schooling. Further studies are needed to clarify the differences in the pathophysiology between sexes and the role of cognitive reserve in prevention of cognitive impairment in HIV infection.
尽管高效抗逆转录病毒治疗（HAART）广泛应用，但神经认知障碍仍然频发。中枢神经系统是已知的HIV感染庇护所，无论病毒是否被抑制，持续性神经炎症都会在此发生。此外，机会性感染、神经血管损伤和HAART神经毒性也会导致神经认知障碍。因此，详细的流行病学研究可能有助于阐明这些复杂机制。
调查巴西南部一家三级中心收治的HIV感染患者中认知障碍的患病率以及相关的社会人口学、临床和神经心理学变量。
2019年2月至2020年3月期间，在Nereu Ramos医院（HNR）对148例HIV感染患者进行了一项观察性、横断面分析研究。对他们进行访谈，采用国际HIV痴呆量表（IHDS）评估，并分析其医疗数据。
认知障碍的患病率为69.6%。女性患病率更高（OR = 3.5；95%CI 1.5 - 8；p < 0.01），且不受抑郁、教育程度和年龄的影响。受教育年限与IHDS评分密切相关（p < 0.01）。患者健康问卷-9（PHQ-9）抑郁评分（p = 0.8）、HIV诊断后的时间（p = 0.2）、CD4细胞计数（p = 0.8）和病毒载量（p = 0.8）与IHDS量表无关。
研究发现HIV感染患者中认知障碍的患病率较高，且独立于性别和受教育年限。需要进一步研究以阐明性别之间病理生理学的差异以及认知储备在预防HIV感染中认知障碍的作用。
