Trastornos neurocognitivos en pacientes VIH positivos

Datos preliminares de una cohorte prospectiva uruguaya

Palabras clave: VIH, TRASTORNOS NEUROCOGNITIVOS, COMPLEJO SIDA DEMENCIA

Resumen

Introducción: la incidencia de formas leves y moderadas de trastornos neurocognitivos (TNC) en pacientes con VIH (virus de inmunodeficiencia humana) permanece en ascenso a pesar del uso de terapia antirretroviral (TARV). En la región existen escasos trabajos que estudiaron los TNC en VIH.
Objetivos: describir características de pacientes con TNC, identificar posibles etiologías y si se realiza su búsqueda.
Material y método: estudio transversal de recolección prospectiva. Se reclutaron en forma consecutiva pacientes de 18 a 60 años VIH positivos sin patología estructural del sistema nervioso central. Se aplicaron exámenes de laboratorio, preguntas para tamizaje de TNC, escala instrumental de actividades de la vida diaria (EIAVD) e internacional de demencia por VIH (EIDV), Adenbrooke’s Cognitive Examination Revisado (ACE-R). ACE-R fue elegida como prueba de referencia de desempeño neurocognitivo. Se utilizó inventario de Beck para pesquisa de trastorno depresivo. Análisis estadístico con sistema SPSS.
Resultados y discusión: se reclutaron 20 pacientes, se diagnosticó TNC en 9/20 (45%). Los médicos tratantes plantearon TNC en 2/9 pacientes. El análisis multivariado encontró asociación entre desempleo (p=0,012) y menor escolarización (p=0,035) en pacientes con TNC. Etiología de TNC en 9/9 fue multifactorial. Refirieron TNC en el tamizaje 8/9 pacientes. EIDV fue adecuada para detección de TNC severo, pero no para leve. EIAVD tampoco logró detectar algunos casos de TNC.
Conclusiones: casi la mitad de pacientes presentaron TNC de causa multifactorial con asociación a desempleo y menor escolarización. Los médicos tratantes no plantearon este diagnóstico, lo que marca la importancia de la evaluación neuropsicológica sistemática en pacientes VIH.

Citas

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Publicado
2019-07-16
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1.
Pérez Sartori G, Iglesias Domínguez C, Feuerstein Rodríguez V, Dansilio S, Medina Presentado J. Trastornos neurocognitivos en pacientes VIH positivos. RMU [Internet]. 16jul.2019 [citado 18oct.2019];35(3):171-80. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/115
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