22 de enero de 2012

Neuropsychiatric aspects of HIV infection among older adults

Fuente original: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864032/
J Clin Epidemiol. Author manuscript; available in PMC 2010 May 4.
Published in final edited form as:
C.H. Hinkin,a* S.A. Castellon,a J.H. Atkinson,b and K Goodkinc
1Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, 760 Westwood Plaza, Room C8-747, Los Angeles, CA 90024, USA
2Psychiatry Service, VA San Diego Healthcare System & Department of Psychiatry, University of California, San Diego, CA, USA
3Departments of Psychiatry and Behavioral Sciences and of Neurology, University of Miami School of Medicine, Miami, FL, USA, Department of Psychology, University of Miami, Coral Gables, FL, USA
*Corresponding author. Tel.: 310-268-4357. chinkin@ucla.edu (C.H. Hinkin)
Treatment advances such as the advent of highly active antiretroviral therapy (HAART) have translated into greater life expectancy for HIV-infected individuals, which will ultimately result in a “graying” of the HIV/AIDS epidemic. In addition, older individuals are engaging in a higher rate of high risk behaviors than had been previously expected. As such, study of older HIV-infected patients, including study of the psychiatric and neurocognitive aspects of the disease, appears highly indicated. Epidemiological studies have demonstrated that HIV infection is associated with higher rates of several psychological/psychiatric disorders when compared to general population base rates. There is also a rich literature that has documented the adverse neurocognitive effects of HIV infection, ranging from subtle cognitive complaints to frank dementia, among younger adults. Although it has been hypothesized that older age may potentiate the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIV-associated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.
Keywords: HIV infection, Older adults, Neuropsychiatric aspects