Valutazione dei Disturbi Neurocognitivi HIV Associati

The introduction of the Combination Anti-Retroviral Therapy (cART) has drastically reduced the morbidity and mortality associated with Acquired Immunodeficiency Syndrome (AIDS) caused by HIV infection: currently, HIV-infected people have a greater survival with an increase in the average age. This fact is destined to grow, so that a real "silver tsunami" is expected, in which about 50% of the HIV-infected in the USA will be around 50 years of age or older. However, among the HIV-infected people, mortality remains higher than in the general population, and chronic diseases, typical of the geriatric age, are more frequently observed, 10-15 years earlier than in the general population. In particular, HIV-infected people are at risk of cognitive impairment (HIV-associated neurocognitive disorders -HAND): also in this context there has been a variation in the presentation spectrum, with a frequency reduction of HIV-Associated Dementia (HAD) and a persistence of the milder forms (ANI, or asymptomatic neurocognitive disorder and MND, or mild neurocognitive disorder). However, adequate screening tools are needed to identify them. Therefore, the aim of our work has been the usefulness evaluation of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a neuropsychological assessment tool widely used in the psycho-geriatric field. We therefore assessed, at zero time (T0), 188 HIV-infected (of which 132 males and 56 females) and, after an interval of 3.8 ± 1.7 years, 74 (39.4%) of them underwent to a second neurocognitive assessment (T1). Our results showed that a high percentage (59%, 111 HIV-infected patients) of our population had an average Total Index Score (RBANS TIS) <85: 98 (52.1%) of them showed a RBANS TIS between 70-84 (one SD below the demographic corrected average), and 71 (72.4%) of them showed an involvement of at least two cognitive areas. The remaining 13 (7%) HIV-infected subjects scored a RBANS TIS <70 (two SD below the demographic corrected average), indicative of probable HAD. The more compromised cognitive areas were immediate and deferred memory and attention. Significantly lower scores at the MMSE (P = 0.0008) and at the Clock Drawing Test (CDT, P = 0.0015) and significantly higher scores at the Geriatric Depression Scale (GDS, P = 0.02) were observed in the group with RBANS TIS <85 respect to RBANS TIS ≥85 group. Considering the RBANS TIS as a dependent variable, in the step-wise phase of the logistic regression, there was a significant positive correlation with the intake of tenofovir / emtricitabine (P = 0.027), with the CDT (P = 0.0125) and with the educational level (P = 0.0054), while the immuno-virologic status was unable to predict the cognitive impairment. From comparison between T0 and T1, no significant differences were observed at the RBANS, except for the Language domain (P = 0.0046). Finally, in all RBANS indices, the score variation between 0 and 4, ≥ +5 and ≥ -5, was classified as "unchanged", "improved" and "worsened", respectively. A relationship between the RBANS score variation and cART modification, in terms of the category of drugs and / or its penetrance in the Central Nervous System (CPE score) has been searched: no significant difference was found. In conclusion, in our study, RBANS had shown to be a useful tool in the early diagnosis of cognitive deterioration during HIV infection, in terms of ease of application, rapidity of administration, repeatability of results and detection earliness of the milder forms of HAND.