Influência dos fatores imunológicos CD4, CD8, razão CD4/CD8 e variáveis sociodemográficas na neurocognição de pessoas vivendo com HIV

Abstract

With the development of antiretroviral therapy (ART), the Human Immunodeficiency Virus (HIV) went from causing a deadly disease to becoming a chronic disease. Despite these advances, people living with HIV and AIDS (PLWHA) still face greater risks of comorbidities compared to the general population, as chronicity involves residual inflammation caused by viral persistence due to the degree of impairment or deterioration of the immune system. The entry of HIV into the Central Nervous System causes metabolic disorders, premature aging and mainly HIV-associated neurocognitive disorder (HAND). The goal of the study is to evaluate the clinical, epidemiological and immunological profile of PLWHA with neurocognitive disorders associated with HIV treated at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus/AM. This is a descriptive and longitudinal study that had been doing from January/2023 to January/2024. PLWHA aged 18 years or over, of both sexes, regularly using ART, undergoing neurological assessment, clinical and laboratory examinations were included. 70 PLWHA participated in the study, divided into three groups: without neurocognitive disorder (non-HAND), asymptomatic deficits and with mild neurocognitive disorder or mild to severe dementia. The same group with mild to severe deficits had the lowest income (p<0,004), as well as the lowest level of education (p<0,005). Our observations indicate that older age, female gender, low educational attainment, and limited income are associated with an increase in cognitive deficits. Immunological markers, such as low levels of CD4 (p<0,023) and CD8, with a decrease in the CD4/CD8 ratio, were associated with cognitive impairment, due to possible immunological exhaustion and a high risk of neuroinflammation. It is suggested that future research includes larger samples and longitudinal approaches, aiming for interventions that combine immunological, psychosocial and behavioral strategies to improve the management of the neurocognitive effects of HIV.