Estudo da prevalência das alterações cognitivas ligadas ao HIV em pacientes portadores da infecção pelo HIV/AIDS

Introduction: Cognitive disorders related to HIV infection have been described since 1987. Initially named HIV dementia complex, its clinical syndrome was characterized as a progressive and very restrictive dysfunction. After HAART introduction in 1996, the prevalence of HIV associated dementia clearly decreased, but other degrees of cognitive impairment were recognized and in 1997, AAN developed a new terminology to classify a broadening clinical spectrum of neurocognitive impairment, including milder abnormalities. Although HAART has greatly reduced medical morbidity and mortality with HIV infection, rates as high as 50% of HIV-associated neurocognitive disorders (HAND) continue to be reported. No data is available regarding cognitive impairment in HIV Brazilian patients. In order to clarify this issue, from a national cohort, we evaluated all kinds of neurocognitive impairment presentation and its prevalence, roaming over some factors (age, gender, educational level, CD4+ nadir and viral load) that could possibly be related to its occurrence. Objectives: To evaluate the neurocognitive disorders presented by a national cohort of HIV/AIDS patients, determining its prevalence, clinical correlates and possible risk factors, and also to evaluate the International Dementia Scale as a possible screening tool to earlier identify individuals at risk for HIV dementia Methods and Material: For a prospective study 187 HIV/ AIDS outpatients from the Clinic of Infectious Diseases at Fiocruz and at the Hospital Municipal Desembargador Leal Junior (53,50% male / 38,50% without HAART use) were randomized based on established selection criteria. Part of the subjects (89/187) underwent evaluation by means of IHDS (International HIV Dementia Scale), administered by a neurologist and by a physiotherapist with a maximum gap of 14 days. Later, all participants completed a screening for comprehensive neuropsychological (NP) battery administered by a neurologist, covering five cognitive domains. Results for each of the neuropsychological tests were compared with the IHDS´s scores. To achieve an interprofessional appraisal, we compared the IHDS´s scores obtained by the neurologist and by the physiotherapist. Data were analyzed using SPSS 17. Results: Cognitive impairment was verified in 52,40% of the selected patients. According to the AAN terminology, 71,50% of them presented a Mild Neurocognitive Disorder while the other 28,50 % already met criteria for HIV associated Dementia. Among the risk factors evaluated, educational level (p-valor = 0,047) and gender (p- valor= 0,030) were considered statistically relevant. IHDS´s interprofessional agreement level was 0,684 and when compared with the NP, its sensitivity was 57%, while its specificity was 77%. Conclusion: The prevalence of HAND in our population is similar to data available regarding international cohorts. IHDS it is easy to perform, requires only 2\20133 minutes, can be provided by nonneurologists, in an outpatient setting, requires no special instrumentation, and detects subcortical damage, such as HIV dementia. However, it should not be used as a replacement for a full neuropsychological testing to confirm a diagnosis of HIV dementia. To diagnose milder forms of cognitive impairment, it has limitations