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)

Summary

Several risk factors may be associated with neurocognitive disorders.

  • Viral factors are the most important risk factor in this population, which requires a better suppression of the virus, reduction untreated/undertreated HIV and promotion of early treatment initiation. Antiretroviral medication and TCD4+ nadir may be also competing factors
  • Brain reserve factors, namely low education/reading attainment, head trauma, ApoE ε4 genotype
  • Metabolic/Cerebrovascular factors that are potentially modifiable by stopping smoking, managing blood pressure, reducing cholesterol, keeping people active, nondiabetic, keeping weight normal. Liver fibrosis may be involved, but less clear given the common underlying issue of inflammation. Nevertheless, keeping a healthy liver and generally healthy overall is likely important
  • Mechanistic factors, related to chronic inflammation, circulating HIV DNA, and monocyte activation, and an eventual T-cells component
  • Age and age-related factors such as ApoE ε4 genotype, cumulative cardiovascular diseases and polypharmacy and prevalence of neurodegenerative conditions
  • Depression, psychiatric factors, which may be considered consequences of HIV infection, but in some cases, can be a manifestation of inadequate HIV control
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