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      Demencia rápidamente progresiva como forma de presentación de infección por el virus de la inmunodeficiencia humana Translated title: Rapidly progressive dementia as the initial presentation of human immunodeficiency virus infection

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          Resumen

          La demencia asociada a virus de la inmunodeficiencia humana (VIH) es una causa de demencia rápidamente progresiva poco frecuente en la actualidad. Su aparición no se limita a las fases tardías de la enfermedad, sino que en ocasiones puede ser el síntoma de presentación.

          Presentamos el caso de un paciente que debutó con síntomas ansioso-depresivos y un rápido deterioro cognitivo con repercusión precoz en su funcionalidad diaria. En el estudio se detectó VIH con mayor carga viral en líquido cefalorraquídeo que en plasma. La terapia antirretroviral logró, a pesar de la tórpida evolución inicial, una mejora progresiva en la esfera cognitiva, congruente con la disminución de la carga viral.

          Aunque poco frecuente, el VIH sigue siendo una causa de demencia que los profesionales de atención primaria y hospitalaria no debemos olvidar. La importancia de su diagnóstico precoz radica en su carácter potencialmente reversible.

          Abstract

          Dementia associated with human immunodeficiency virus (HIV) is currently a rare cause of rapidly progressive dementia. Its appearance is not only limited to the late phases of the disease, but can sometimes be the presenting symptom.

          We present the case of a patient who debuted with anxious-depressive symptoms and rapid cognitive deterioration with early repercussions on his daily functionality. HIV was detected in the study, with a higher viral load in cerebrospinal fluid than in plasma. Despite a torpid course at the beginning, antiretroviral therapy brought about a progressive improvement in the cognitive sphere, consistent with the decrease in the viral load.

          Although rare, HIV continues to be a cause of dementia that primary care and hospital care professionals should not forget. The relevance of its early diagnosis lies in its potentially reversible nature.

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          Rapidly Progressive Dementia.

          Michael Geschwind (2016)
          This article presents a practical and informative approach to the evaluation of a patient with a rapidly progressive dementia (RPD).
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            HIV-1 infection and cognitive impairment in the cART era: a review.

            Peter Reiss, P Portegies, Henk J. Schouten … (2011)
            With the introduction of combination antiretroviral therapy AIDS dementia complex or HIV-associated dementia, as it was termed later, largely disappeared in clinical practice. However, in the past few years, patients, long-term infected and treated, including those with systemically well controlled infection, started to complain about milder memory problems and slowness, difficulties in concentration, planning, and multitasking. Neuropsychological studies have confirmed that cognitive impairment occurs in a substantial (15-50%) proportion of patients. Among HIV-1-infected patients cognitive impairment was and is one of the most feared complications of HIV-1 infection. In addition, neurocognitive impairment may affect adherence to treatment and ultimately result in increased morbidity for systemic disease. So what may be going on in the CNS after so many years of apparently controlled HIV-1 infection is an urgent and important challenge in the field of HIV medicine. In this review we summarize the key currently available data. We describe the clinical neurological and neuropsychological findings, the preferred diagnostic approach with new imaging techniques and cerebrospinal fluid analysis. We try to integrate data on pathogenesis and finally discuss possible therapeutic interventions.
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              The risk of late or advanced presentation of HIV infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian MASTER Cohort

              Elena Raffetti, Maria Postorino, Francesco Castelli … (2016)
              Background We aimed at evaluating frequency and factors associated with late presentation and advanced HIV disease and excess risk of death due to these conditions from 1985 to 2013 among naïve HIV infected patients enrolled in the Italian MASTER Cohort. Methods All antiretroviral naive adults with available CD4+ T cell count after diagnosis of HIV infection were included. Multivariable logistic regression analysis investigated factors associated either with late presentation or advanced HIV disease. Probabilities of survival were estimated both at year-1 and at year-5 according to the Kaplan-Meier method. Flexible parametric models were used to evaluate changes in risk of death overtime according to late presentation and advanced HIV disease. The analyses were stratified for calendar periods. Results 19,391 patients were included (54 % were late presenters and 37.6 % were advanced presenters). At multivariable analysis, the following factors were positively associated with late presentation: male gender (OR = 1.29), older age (≥55 years vs. <25 years; OR = 7.45), migration (OR = 1.54), and heterosexual risk factor for HIV acquisition (OR = 1.52) or IDU (OR = 1.27) compared to homosexual risk. Survival rates at year-5 increased steadily and reached 92.1 % for late presenters vs. 97.4 % for non-late presenters enrolled in the period 2004–2009. Using flexible parametric models we found a sustained reduction of hazard ratios over time for any cause deaths between late and non-late presenters over time. Similar results were found for advanced HIV disease. Conclusion Screening polices need to be urgently implemented, particularly in most-at-risk categories for late presentation, such as migrants, older patients and those with heterosexual intercourse or IDU as risk factors for HIV acquisition. Although in recent years the impact of late presentation on survival decreased, about 10 % of patients diagnosed in more recent years remains at increased risk of death over a long-term follow-up. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3477-z) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Journal ID (nlm-ta): An Sist Sanit Navar
                Journal ID (iso-abbrev): An Sist Sanit Navar
                Journal ID (publisher-id): assn
                Title: Anales del Sistema Sanitario de Navarra
                Publisher: Gobierno de Navarra. Departamento de Salud
                ISSN (Print): 1137-6627
                ISSN (Electronic): 2340-3527
                Publication date (Electronic, pub): 16 August 2022
                Publication date (Electronic, collection): May-Aug 2022
                Volume: 45
                Issue: 2
                Electronic Location Identifier: e1002
                Affiliations
                [1 ] originalServicio de Neurología. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España. normalizedHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Neurología orgnameHospital Clínico Universitario Lozano Blesa Zaragoza, Spain
                [2 ] originalInstituto de Investigación Sanitaria de Aragón. Zaragoza. España. orgnameInstituto de Investigación Sanitaria de Aragón Zaragoza, España
                [3 ] originalServicio de Medicina Interna. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España. normalizedHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Medicina Interna orgnameHospital Clínico Universitario Lozano Blesa Zaragoza, Spain
                [4 ] originalServicio de Enfermedades Infecciosas. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España. normalizedHospital Clínico Universitario Lozano Blesa orgdiv1Servicio de Enfermedades Infecciosas orgnameHospital Clínico Universitario Lozano Blesa Zaragoza, Spain
                Author notes
                [Correspondencia ] Sara Ballesta Martínez. Hospital Clínico Universitario Lozano Blesa, Servicio de Neurología, 50009, Zaragoza, España. E-mail: ballesta.sara@ 123456gmail.com

                Conflictos de intereses: Los autores declaran no tener conflictos de intereses.

                Article
                DOI: 10.23938/ASSN.1002
                PMC ID: 10130791
                PubMed ID: 35972310
                SO-VID: 19c8da7d-2362-46c5-8b0e-5e3f5073b8c1
                License:

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                Date received : 12 January 2022
                Date revision received : 20 April 2022
                Date accepted : 17 May 2022
                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 10, Pages: 0
                Categories
                Subject: Notas Clínicas

                Keywords: virus de la inmunodeficiencia humana,vih,demencia por vih,human immunodeficiency virus,hiv,hiv dementia
                Data availability:
                Keywords: virus de la inmunodeficiencia humana, vih, demencia por vih, human immunodeficiency virus, hiv, hiv dementia

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