S-adenosylmethionine (SAM-e) for the treatment of depression in people living with HIV/AIDS

BACKGROUND: This study reports on clinical data from an 8-week open-label study of 20 HIV-seropositive individuals, diagnosed with Major Depressive Disorder (DSM-IV), who were treated with SAM-e (S-Adenosylmethionine). SAM-e may be a treatment alternative for the management of depression in a population reluctant to add another "pill" or another set of related side effects to an already complex highly active antiretroviral therapy (HAART) regimen. METHODS: The Hamilton Rating Scale for Depression (HAM-D) and the Beck Depression Inventory (BDI) were used to assess depressive symptomatology from 1,2,4,6 and 8 weeks after initiation of treatment with SAM-e. RESULTS: Data show a significant acute reduction in depressive symptomatology, as measured by both the HAM-D and the BDI instruments. CONCLUSIONS: SAM-e has a rapid effect evident as soon as week 1 (p < .001), with progressive decreases in depression symptom rating scores throughout the 8 week study

Características e tendência da AIDS entre idosos no Estado do Espírito Santo Features and trend of AIDS, among the elderly in the State of Espirito Santo

INTRODUÇÃO: A AIDS entre adultos mais velhos é um problema de saúde pública emergente. Comparamos o perfil epidemiológico e sociodemográfico, bem como a evolução e a tendência da epidemia entre homens e mulheres nas faixas etárias de 50 anos e mais e 20 a 39 anos acometidos pela AIDS, no Estado do Espírito Santo, Brasil. MÉTODOS: Realizamos um estudo de série temporal, com dados secundários do SINAN/AIDS, no período de Janeiro de 1991 a dezembro 2006. RESULTADOS: Neste período, foram notificados 3.382 casos de AIDS em indivíduos com idade entre 20 e 39 anos e 551 casos entre indivíduos com 50 anos e mais. Em ambas as faixas etárias, os mais acometidos são os homens. Há diferenças referentes à raça/cor, em que a maioria dos mais velhos são brancos (45,3% - p-valor = 0,044) e os mais jovens pardos (44,7%, p-valor = 0,003). O analfabetismo prevalece entre os mais velhos (17,7% - p-valor = 0,001). Mais da metade (80%) das notificações ocorreu em municípios de médio a grande porte. A principal categoria de exposição foi a heterossexual, em ambos as faixas etárias, com maior frequência para o grupo de 50 anos ou mais (77,3% - p=0,0001). A incidência acumulada é maior para a faixa etária de 20 a 39 anos (R²=0,68); porém, vem aumentando proporcionalmente, entre as duas faixas no decorrer dos anos, com tendência de crescimento significativa para ambas (p <0,01). CONCLUSÕES: A epidemia de AIDS pode ser considerada em expansão entre mais velhos no Espirito Santo.<br>INTRODUCTION: AIDS among older adults is a public health problem emerging. This study compared the demographic and epidemiological profile and the evolution and trend of the epidemic among men and women aged 50 years and older and 20 to 39 years affected by AIDS in the State of Espirito Santo, Brazil. METHODS: We conducted a time serie study with secondary data from SINAN/AIDS for the period January 1991 to December 2006. RESULTS: In this period were 3,382 reported cases of AIDS in individuals aged 20 to 39 years and 551 cases among individuals with 50 years or older. In both age groups most affected are men. There are differences related to race or color, where the majority of the older is white (45.3% - p-value = 0.044) and the young brown (44.7%, p = 0.003). Illiteracy prevails among the older (17.7% - p-value = 0.001). More than half (80%) of the notifications occurred in cities of medium to large. The main risk factor was heterosexual in both the age groups more frequently to the group of 50 or more (77.3% - p = 0.0001). The cumulative incidence is higher for the age group 20 to 39 years (R² = 0.68), but is increasing proportionally between the two bands over the years, with a significant upward trend for both (p<0.01). CONCLUSIONS: The AIDS epidemic among the elderly can be seen growing among older on the Espirito Santo State

Impact of HIV and aging on neuropsychological function

Cognitive efficiency decreases with age, and advancing age is the leading risk factor for most neurodegenerative disorders that result in dementia. In HIV infection, risk for cognitive impairment is consistently linked to advancing chronological age. As the HIV epidemic enters its fourth decade in the USA, extended life expectancy will likely result in an increased prevalence of cognitive disorders by virtue of these factors. However, it is less clear if HIV potentiates or accelerates the risk for cognitive impairment given that most reports are mixed or demonstrate only a small interaction effect. More critically, it is unclear if HIV will modulate the neuropathology associated with non-HIV cognitive disorders in a manner that will increase risk for diseases such as cerebrovascular and Alzheimer’s disease. In the coming years, with increasing numbers of HIV+ patients entering their 60s and 70s, background risk for neurodegenerative disorders will be sufficiently high as to inform this issue on clinical grounds. This review summarizes knowledge of cognition in HIV as it relates to age and presents some emerging controversies