Módulo 3 – Curso pós-graduado – VIH e Envelhecimento

Neurocognitive Disorders in HIV Infected Patients

Risk factors for neurocognitive disorders in the setting of HIV infection

Autor: Prof. DoutorVictorValcour, MD PhD (Memory and Aging Center, University of California, San Francisco, USA)

Key menssages

  • Viral factors are important risk factors for HAND, thus requiring suppression of virus, the reduction untreated/undertreated HIV and promotion of early treatment initiation.
  • Brain reserve factors, low education/reading attainment, head trauma, ApoE ε4 genotype are other risk factors to be considered in HIV patients.
  • Cardiovascular risk factors are potentially modifiable, namely smoking, blood pressure, reducing cholesterol, physical activity, diabetes, obesity.
  • Age and age-related factors such as ApoE ε4 genotype, cumulative cardiovascular diseases and polypharmacy and prevalence of neurodegenerative conditions are also important risk factors for this aging HIV-infected population.
  • Other likely virus/mechanistic factors include neurotoxicity and, infrequently, CNS penetration of antiretroviral medication, TCD4+ nadir, chronic inflammation, circulating HIV DNA, and monocyte activation.
  • Depression, psychiatric factors may be considered consequences of HIV infection but, in some cases, can be a manifestation of inadequate HIV control.
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