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Utegenova Sohiba Komilovna, The Research Institute of Virology the Ministry of Health Tashkent, Uzbekistan Bayjanov Allabergan Kadirovich, chief doctor of Samarkand Regional Clinical Infectious Disease Hospital, Samarkand E-mail: evovision@bk.ru
FACTORS AFFECTING NEUROCOGNITIVE FUNCTIONS OF PATIENTS WITH HIV INFECTION
Abstract: Reasonable adaptation of patients with HIV infection is aimed at distributing their strength, taking into account the objective limitations arising from the disease, as well as its potential preserved. Keywords: HIV infection, neurocognitive functions.
The aim of the work was to analyze the scientific literature devoted to the influence of factors on the cognitive functions of HIV patients, as neurocognitive impairments are one of the main factors influencing the effectiveness of antiretroviral therapy (ART) in HIV patients. The study of the degree of disruption of cognitive functions of the body in patients with HIV before prescribing ART will make it possible to improve the quality of the effectiveness of specific therapy in this category of patients. At present, a large number of risk factors for the development of neurocognitive impairments in HIV infection are known, the diagnosis of which is difficult, especially at the initial stages of HIV infection due to the absence of significant clinical manifestations of this condition. It is known that the human immunodeficiency virus (HIV) penetrates the central nervous system (CNS) in the early stages of the disease and infects microglia and macrophages [1].
Factors associated with the human body include genetic predisposition, metabolic disorders, age, vascular diseases, anemia and nutritional deficiencies, and the factors associated with the immunodeficiency virus include are the following: the state of the virus at the clinical stage - AIDS, immunity activation, subtypes of the virus, neuroadaptation and the resistance of the virus to the antiretrovirals. Also, the accompanying diseases (conditions) plays following role: stress, using psychoactive drugs, viral hepatitis C, depression, tuberculosis and other opportunistic diseases. An important role is played by the activity of antiretroviral and other drugs and side effects of the used drugs. At the beginning of the epidemic, it was believed that the decline in cognitive function in patients before the development of the AIDS stage does not depend on the degree of immunodeficiency, determined by the number of CD4 lymphocytes [2], although the atrophy of the cerebral cortex was noted even in the background ofART [3]. At present, it has been established that on the background ofART, the thinning of the cerebral cortex is significantly associated with
the detectable viral load of HIV [4] and that the improvement in cognitive functions is due to its decrease [5], although it does not completely eliminate these disorders.
There is evidence that genetic differences in HIV subtypes, as well as genetic data and age, play an important role in the development of HIV-associated neurocognitive disorders [6], although not all researchers confirm this. Thus, the differences in the effect ofthe studied HIV subtypes on neuropsychological and volumetric indices of the brain against the background of ART were not revealed [7], although it was noted that patients with the HIV-B subtype had higher CD4 lymphocyte counts and a lower viral load of the immunodeficiency virus compared with patients infected with HIV-C-subtype.
Differential diagnosis of neurocognitive disorders should be carried out with clinical manifestations of brain damage of another (not caused by HIV) etiology/, as well as deficient states (deficiency of B vitamins, zinc), endocrine disorders (thyroid disease, adrenal insufficiency), mental disorders in particular, manic-depressive psychosis, obsessive-compulsive disorder, use of psychoactive substances). In addition, toxic side effects of medications (including antiviral drugs - efavi-renz, etravirine, in rare cases lamivudine, abacavir, corticoste-roids, interferon) should be considered separately, which, as a rule, affects the quality of life of patients, lead to a change in therapy, but more expensive.
Currently, HIV-associated neurocognitive impairments are a common problem, even in patients with the desired level of CD4 lymphocytes and an undetectable level of viral load of HIV [8].
It was shown that asymptomatic neurocognitive disorders were noted in about half of the patients examined against a background of viral suppression (HIV viral load less than 50 copies/^l) [9]. Moreover, there was no significant difference in the presence of cognitive impairment in persons with a detectable and undetectable viral load [10].
Medical science
It was noted that in the majority of cases, improvement of cognitive processes occurs in 24-36 weeks from the initiation of therapy in the interval of 12-48 weeks (although in approximately 5% of cases, significant deterioration of these indicators was noted [11], and persists for one year (observation period) It is believed, in particular, that learning and memory are significantly associated with the adherence to the treatment [12].
There is also evidence of the relationship between cognitive function and the severity of depression [13] (although in some studies, there is no reliable association between cognitive impairment rates and symptoms of depression [14]), and the relationship between cognitive function and CD4 lymphocyte counts. In addition to depression, stigmatization and social disorder of patients also have a direct and indirect impact on cognitive functions [15].
In addition, it is believed that improving the treatment of co-morbidities that are common in populations of HIV patients (eg, viral hepatitis C, liver failure, metabolic syndrome) is crucial, as some of these subjects are known to have significant effects on neuronal functions, although these relationships on the background of ART remain not completely clear [16].
It is shown that the development of cognitive impairment is more associated with the risk of vascular disease than with the number of CD4 lymphocytes and the level of viral load [17].
The HCV-core antigen has high immunogenic properties, and its high level can cause disorders of some brain functions [18]. It was noted that infection with the hepatitis C virus causes an additional deterioration in cognitive functions, even against the background of controlled HIV infection [19].
Data on the relationship of cognitive impairment with ophthalmic lesions could not be found in the literature available to us. At the same time, it was noted that HIV-1 is found in tear
fluid even against the background of effective ART (this indicates that the lacrimal gland or other tissues and structures of the tear apparatus can serve as a reservoir for the virus) [20].
In conclusion, it should be noted that the reasonable adaptation of patients with HIV infection is aimed at distributing their forces both in view of the objective limitations that have arisen in connection with the disease, and taking into account its preserved potential opportunities. However, if difficulties usually do not arise with the establishment of the somatic status of such persons, then the question has not been finally resolved regarding their neuropsychological conditions. However, the recommendations to this effect have not been adequately worked out. At the same time, even with the intellectual indices kept within the limits of the average norm, it is impossible to say with certainty the absence of cognitive impairments, since there is no information on the patient's prior intellectual level of the intellect. As a consequence, it is not possible to reliably estimate the decrease, in particular, of cognitive indices in the dynamics of the clinical state of the patient. It is believed that exacerbating risk behaviors and suboptimal adherence to treatment can exacerbate cognitive impairment, but the latter also reduce the effectiveness of interventions to optimize adherence and reduce risk. It is known that therapy aimed only at improving laboratory indicators, while ignoring the physical and mental well-being of a person can not remain effective for a long time.
These issues can be solved only on the basis of early active detection and timely clinical, laboratory, instrumental diagnosis of neurocognitive impairment in patients with HIV infection and the application of modern methods of treatment, competent psychological and social support of patients, taking into account the identified changes.
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