Abdul, Rahuman (2009) A Study on Pattern of Neuropsychological Performance in HIV Positive Patients and Impact of Antiretroviral Therapy in Cognitive Impairment. Masters thesis, Madurai Medical College, Madurai.
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Abstract
Introduction: HIV infection is a global pandemic, with cases of AIDS reported in Nearly every country in the world. Infection with the human Immunodeficiency virus-type-1 (HIV-1) can have a significant impact on The central nervous system (CNS) as well as on the immune system. Michael Gottlieb(1981) diagnosed with Pneumocystis carinii pneumonia In a gay man and some rare cases of Kaposi’s sarcoma were diagnosed During the same period. All these patients were strangely immuno Deficient—their immune systems could not fight off even simple Infections. Other opportunistic infections accompanied these diagnoses. The initial diagnosis was given the incriminating acronym GRID, Gay Related Immunodeficiency Disease. Since male homosexuals and Intravenous drug users were frequent blood donors, for both altruistic and Financial reasons, the blood supply was quickly tainted. Suddenly Hemophiliacs living outside the usual risk areas, who needed Factor VIII, Which was extracted from the whole blood of thousands of donors, came Down with the same symptoms. During 1982 AIDS was diagnosed Among hemophiliacs and injection drug users (idus). Later the first case Of heterosexual transmission was identified in USA.(centers for disease Control and prevention, 1983). The first studies performed by the CDC in 1981 traced the sexual Contacts of a small group of 40 patients suffering from KS, PCP, and/or Other opportunistic infections. All cases could be traced to the single Index case, called Patient Zero, a French Canadian flight attendant Gaetan Dugas. Although Dugas was not the first person to show Symptoms of HIV infection, he was the center of this particular cohort of Diseased individuals. The earliest fully documented case of HIV dates Back to 1959. A Congolese man's blood sample from a medical study was Preserved, found, and then analyzed in 1998. It was verified that he had Been HIV+. Other suspected, but unverified because of the lack of either Blood or tissue samples, cases date back as early as 1934. Since the identification of HIV in 1981 ,neurologists described Several HIV-related central nervous system (CNS) syndromes within the First several years of the epidemic. Mental health professionals from Nursing, social work, psychology, and psychiatry followed the plight of Patients of the epidemic and helped to mobilize interest and galvanize a Response. Initially, much of the work focused on grief and loss issues, as Well as supportive psychotherapy, but quickly broadened to recognize a Number of specific psychiatric conditions, including acquired immune Deficiency syndrome (AIDS) dementia, Cognitive Impairment, the Associated AIDS mania, increased rates of major depression, and Psychiatric consequences of CNS injuries. Neuropsychiatric disorders in HIV can be either primary or Secondary. Primary complications are those that can be attributed directly To the infection of the central nervous system by the virus, or to imuno Pathological events precipitated by HIV infection. Primary HIV-related Brain disorders include HIV-related dementia and minor cognitive Disorder. Immune suppression can lead to a variety of secondary Complications affecting the brain, including opportunistic infections (e.g. Cerebral toxoplasmosis and progressive multifocal leucoencephalopathy) And tumours (e.g. Cerebral lymphoma). Secondary complications in the Form of acute and subacute syndromes (e.g. Delirium) often occur as a Result of cerebrovascular complications and toxic states induced by Various therapeutic agents. Five percentage of newly diagnosed AIDS cases and 60% in late AIDS have been found to be impaired, (Tozzi et al, 2005, Cysique et al ,2004, Yepthomi et al ,2006). Neuropsycholgical impairment caused by HIV was found in the areas of attention and concentration, abstraction, Learning, memory, psychomotor and cognitive processing speed in several Studies.(Bornstein et al., 1993; Heaton et al., 1995; mcarthur and Seines, 1997, Glen et al, 2005). Age, CD4 count, Education, Employment are the some of the Factors predicting the development of cognitive impairment, proposed by Few literatures. Pharmacologic treatment strategies for cognitive disorders can be Divided into four types: 1) antiretroviral therapies, 2) therapies aimed at Immunological measures or inflammatory mediators, 3) therapies aimed At bolstering the response of the brain to the onslaught of the infection (e.g., neurotransmitter manipulation), and 4) nutritional therapies. Most Controlled studies have investigated the efficacy of antiretroviral Therapies, and while these studies have advanced our knowledge about Interventions for cognitive disorders, several key factors required to be Considered. First is the fact that most published studies to date report on The treatment strategy of administering a single antiretroviral agent. Their Findings are therefore difficult to interpret in light of the multi drug Regimens that are now the standard of care in developed countries. Second, the reports vary widely with regard to the study population, since Some studies enrolled subjects on the basis of established criteria for HIV-associated dementia or minor cognitive motor disorder but other Studies enrolled cognitively impaired subjects without Specifying Whether they also met criteria for a clinical disorder. Third, the range of HIV clinical severity also varied widely in study subjects. Whether Antiretroviral agents penetrate the blood-brain barrier sufficiently to Adequately suppress viral replication is a key issue that requires further Study. Scope of this study: This study focused on the primary neuropsychiatric disorders of HIV and cognitive impairment in particular. There is some evidence to Suggest that CD4 count was an important predictor of the development of Immune deficiency and subsequent cognitive impairment. .This study Aims to corroborate on the prevalence of cognitive impairment in HIV Patients and to know whether CD4 count are correlated with the Impairment and the effect of antiretroviral therapy in the cognitive Impairment Plan of the study: The present study has been planned as follows Review of Literature Methodology Results and Interpretation Discussion Conclusion
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Pattern ; Neuropsychological Performance ; HIV Positive Patients ; Impact Antiretroviral Therapy ; Cognitive Impairment. |
| Subjects: | MEDICAL > Psychiatry |
| Depositing User: | Subramani R |
| Date Deposited: | 19 Aug 2017 02:50 |
| Last Modified: | 19 Aug 2017 02:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1927 |
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