La demencia asociada a infección por virus de inmunodeficiencia humana (DVIH) es una entidad caracterizada por la tríada de compromiso cognitivo, síntomas conductuales y motores, que generan serias dificultades en la capacidad funcional del paciente. Las múltiples denominaciones generan confusión y alta probabilidad de subreconocimiento. No obstante, la incidencia de DVIH es controversial; se tiene claro que más de 90% de pacientes con sida tiene anormalidades neuropatólogicas compatibles con DVIH. Los mecanismos patogénicos involucran una compleja interacción entre el VIH y las células del cerebro, que generan claramente dos vías incluyentes, la inflamatoria y la no inflamatoria, las cuales generan factores neurotóxicos y quimiotácticos, inductores de apoptosis, que conducen a una disrupción neuronal-glial, probablemente responsable de la injuria y/o muerte neuronal, que conduciría a un fenómeno de neurodegeneración acelerada. Los síntomas son de una demencia subcortical, siendo los síntomas de presentación más comunes el compromiso de la memoria, enlentecimiento mental, dificultad para la marcha y depresión. El diagnóstico es esencialmente clínico y se realiza por exclusión. Son de utilidad práctica la HIV Dementia Scale (HDS) y la International HIV Dementia Scale (IHDS), como pruebas iniciales de descarte. El tratamiento debe incluir la combinación de antiretrovirales y neuroprotectores. Como conclusión, la DVIH es una complicación devastadora de la infección por VIH que debe ser reconocida tempranamente.
English Version
ABSTRACT
Dementia associated to human immunodeficiency virus infection (DHIV) is an entity distinguished by three main signs -cognitive, behavioral and motor symptoms- which generate serious difficulties in the functional capacity of the patient. The multiple denominations generate confusion and diagnostic difficulties. In spite of controversy in DHIV incidence, it is clear that more than 90% of patients with AIDS has compatible neuropathological anormalities with DHIV. The pathogenic mechanisms involve complex interactions between the HIV and the brain cells generating two inclusive paths, inflammatory and non inflammatory, that produce neurotoxic and chemotactic factors, inductors of apoptosis that lead to neuro-glial disruption probably responsible of injury and/or neuron cell death, that finally would lead to accelerated neurodegeneration phenomenon. Symptoms are subcortical dementia, mental sluggishness, walking difficulties and depression. Diagnosis is essentially clinical and by exclusion. The HIV Dementia Scale (HDS) and the International HIVD Scale (IHDS) are of practical usefulness as initial screening tests. Treatment should include the combination of antiretrovirals and neuroprotectors. We conclude that DHIV is a devastating complication of HIV infection that should have early recognition.
English Version
ABSTRACT
Dementia associated to human immunodeficiency virus infection (DHIV) is an entity distinguished by three main signs -cognitive, behavioral and motor symptoms- which generate serious difficulties in the functional capacity of the patient. The multiple denominations generate confusion and diagnostic difficulties. In spite of controversy in DHIV incidence, it is clear that more than 90% of patients with AIDS has compatible neuropathological anormalities with DHIV. The pathogenic mechanisms involve complex interactions between the HIV and the brain cells generating two inclusive paths, inflammatory and non inflammatory, that produce neurotoxic and chemotactic factors, inductors of apoptosis that lead to neuro-glial disruption probably responsible of injury and/or neuron cell death, that finally would lead to accelerated neurodegeneration phenomenon. Symptoms are subcortical dementia, mental sluggishness, walking difficulties and depression. Diagnosis is essentially clinical and by exclusion. The HIV Dementia Scale (HDS) and the International HIVD Scale (IHDS) are of practical usefulness as initial screening tests. Treatment should include the combination of antiretrovirals and neuroprotectors. We conclude that DHIV is a devastating complication of HIV infection that should have early recognition.
Artículo completo: http://www.neuroconsultas.com/web/images/stories/pdf/demencia_vih.pdf
Publicación:
Revista Anales de la Medicina
Universidad Nacional Mayor de San Marcos
Setiembre 2006
No hay comentarios:
Publicar un comentario