Prevalencia y factores asociados a trastorno neurocognitivo en personas con infección por VIH y viremia suprimida

El tratamiento antirretroviral (TAR) ha cambiado radicalmente la historia natural de la infección por VIH. En los países con acceso al TAR, ha disminuido la incidencia de sida y muerte en las personas infectadas por VIH, y consecuentemente ha producido una ganancia considerable de años vividos. Sin embargo, la cronicidad de la infección se acompaña de un aumento en la incidencia de determinadas enfermedades en la población con infección por VIH superior a la observada en población general. Esta mayor incidencia de comorbilidades se explicaría por la propia cronicidad de la infección y la inflamación sistémica que provoca, además de los factores de riesgo conocidos y asociados a determinadas enfermedades. Una de estas comorbilidades, es el trastorno neurocognitivo asociado a la infección por VIH (HAND, por sus siglas en inglés HIV-associated disorder), y constituye el objeto de estudio de esta Tesis. El HAND se asocia a peor adhesión al TAR, mayor dificultad en las actividades de la vida diaria, peor calidad de vida y mayor riesgo de mortalidad. Los estudios que han analizado la prevalencia actual de HAND muestran datos muy variables dependiendo de la población estudiada. El nivel de control virológico de la infección y la existencia de otras comorbilidades asociadas a trastorno neurocognitivo pueden actuar como factores de confusión. Los objetivos de nuestro estudio fueron analizar la prevalencia y los factores asociados a HAND en personas con infección por VIH que reciben un TAR eficaz y sin co-morbilidades médicas asociadas a deterioro neurocognitivo. Analizar la prevalencia de patrones clínicos de personalidad y síndromes clínicos en esta población y su asociación con el diagnóstico de HAND. Por último, estudiamos la asociación entre las variables biológicas y de inflamación de la infección por VIH con los dominios cognitivos alterados en la población a estudio

PREVALENCIA Y FACTORES ASOCIADOS A TRASTORNOS DE LA PERSONALIDAD Y SÍNDROMES CLÍNICOS DEL MCMI-III EN PACIENTES CON INFECCIÓN POR VIH CON BUENA RESPUESTA AL TRATAMIENTO ANTIRRETROVIRAL

El tratamiento antirretroviral (TAR) ha conseguido convertir al VIH en una enfermedad crónica y no letal. La eficacia depende de la adhesión al tratamiento, en una población con elevada frecuencia de trastornos psicológicos. Objetivo: Analizar la presencia de trastornos de personalidad y síndromes clínicos del MCMI-III en pacientes con infección por VIH con buen control virológico e inmunológico y su relación con las variables sociodemográficas y clínicas de la infección por VIH. Método: Estudio observacional en pacientes con infección VIH en TAR con buen control virológico y con criterios de exclusión para eliminar factores de confusión. Administramos el cuestionario clínico MCMI-III autoaplicado de evaluación de la personalidad y síndromes clínicos. Analizamos su relación con variables sociodemográficas y clínicas relacionadas el VIH. Resultados: Se incluyeron 78 pacientes. Los trastornos de personalidad más prevalentes fueron: compulsivo (35,8%), narcisista (25,5%) e histriónico (10,2%). Los síndromes clínicos más prevalentes fueron: ansiedad (21,8%), trastorno bipolar (11,5%) y dependencia de sustancias (10,2%). En los varones homosexuales predominaba la personalidad narcisista. Los pacientes con antecedentes de uso de drogas intravenosas presentaban un menor recuento de linfocitos CD4+, CD4+ nadir, más tiempo de exposición al VIH, personalidad antisocial, agresiva y trastorno bipolar. Discusión: No hemos observado una mayor patología en la población estudiada respecto a la población general. Las relaciones encontradas son útiles para mejorar la adhesión al TAR, su malestar psicológico y por tanto el pronóstico de los pacientes.Antiretroviral therapy (ART) has managed to turn HIV infection into a chronic, not deadly disease. The efficacy of ART depends on the adherence in a population with high prevalence of psychological disorders. Objetive: Analyze the presence of personality disorders and clinical syndromes of MCMI-III in HIV infected patients with good virological and immunological control, and its relationship with sociodemographic and clinical characteristics of HIV infection. Methods: Observational study of HIV-infected patients on ART with good virological control and exclusion criteria to eliminate confounders. We used the MCMI-III clinical self-administered questionnaire for assessing personality and clinical syndromes. We also analyzed its relation with clinical and sociodemographic variables related HIV. Results: 78 patients were included. The most prevalent personality disorders were: compulsive (35.8%), narcissistic (25.5%) and histrionic (10.2%). The most prevalent clinical syndromes were: anxiety (21.8%), bipolar disorder (11.5%) and substance dependence (10.2%). In gay men dominated narcissistic personality. Patients with previous intravenous drug use were associated with lower CD4 + lymphocytes, CD4 + nadir, longer exposure to HIV, antisocial personality, aggressive and bipolar disorder. Discussion: We did not observed more frequency of personality disorders and clinical syndromes in the HIV-population studied compared to general population. The relationships found are useful for improving adherence to ART, their psychological distress and therefore the prognosis of patients

Prevalencia y factores asociados a trastorno neurocognitivo en personas con infección por VIH y viremia suprimida

El tratamiento antirretroviral (TAR) ha cambiado radicalmente la historia natural de la infección por VIH. En los países con acceso al TAR, ha disminuido la incidencia de sida y muerte en las personas infectadas por VIH, y consecuentemente ha producido una ganancia considerable de años vividos. Sin embargo, la cronicidad de la infección se acompaña de un aumento en la incidencia de determinadas enfermedades en la población con infección por VIH superior a la observada en población general. Esta mayor incidencia de comorbilidades se explicaría por la propia cronicidad de la infección y la inflamación sistémica que provoca, además de los factores de riesgo conocidos y asociados a determinadas enfermedades. Una de estas comorbilidades, es el trastorno neurocognitivo asociado a la infección por VIH (HAND, por sus siglas en inglés HIV-associated disorder), y constituye el objeto de estudio de esta Tesis. El HAND se asocia a peor adhesión al TAR, mayor dificultad en las actividades de la vida diaria, peor calidad de vida y mayor riesgo de mortalidad. Los estudios que han analizado la prevalencia actual de HAND muestran datos muy variables dependiendo de la población estudiada. El nivel de control virológico de la infección y la existencia de otras comorbilidades asociadas a trastorno neurocognitivo pueden actuar como factores de confusión. Los objetivos de nuestro estudio fueron analizar la prevalencia y los factores asociados a HAND en personas con infección por VIH que reciben un TAR eficaz y sin co-morbilidades médicas asociadas a deterioro neurocognitivo. Analizar la prevalencia de patrones clínicos de personalidad y síndromes clínicos en esta población y su asociación con el diagnóstico de HAND. Por último, estudiamos la asociación entre las variables biológicas y de inflamación de la infección por VIH con los dominios cognitivos alterados en la población a estudio

Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis

The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: “health-related quality of life”, “HQRoL”, “HIV”, “AIDS”, “advanced HIV disease” and “low CD4 cells”. Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case–control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.El objetivo del estudio fue evaluar los efectos de la enfermedad avanzada de sida (EAS) en la calidad de vida relacionada con la salud (CVRS) en personas que viven con el VIH (PVVIH), los cambios experimentados en la CVRS en los últimos 25 años y las diferencias entre países. Realizamos una revisión sistemática y metaanálisis. La búsqueda se llevó a cabo en PubMed y Web of Science utilizando los términos: “calidad de vida relacionada con la salud”, “CVRS”, “VIH”, “SIDA”, “enfermedad avanzada por VIH” y “células CD4 bajas”. Los criterios de inclusión de los estudios fueron: población adulta; iniciado después de 1996 y publicado antes de julio de 2021; ensayos clínicos, estudios transversales, de cohorte y de casos y controles; estudios que analizan la relación entre EAS y CVRS; idioma inglés o español. Se calcularon diferencias de medias estandarizadas (d+) para estimar el tamaño del efecto para los metaanálisis. Los efectos promedios se calcularon utilizando un modelo de efectos aleatorios, y el análisis de moderadores utilizando modelos de efectos mixtos. El metaanálisis incluyó 38 estudios. Los resultados indicaron que la CVRS es peor en pacientes con EAS en comparación con aquellos sin EAS. Los principales dominios de CVRS afectados son la percepción de salud general y su preocupación, y la función física y de salud y los síntomas asociados. Encontramos un impacto moderado por edad y género en algunos dominios de CVRS. No encontramos diferencias en cuanto a las desigualdades socioeconómicas, país de residencia o período de tiempo analizado. En conclusión, la enfermedad avanzada por VIH tiene un impacto negativo en la salud y el bienestar en las personas con VIH. Nuestros resultados muestran que, a pesar de todos los avances en los tratamientos antirretrovirales en los últimos 25 años, el EAS persiste como una fuente de extrema vulnerabilidad, independientemente de dónde vivan las personas con VIH.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature

Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.This research was funded by the Office of the Vice President of Research and Knowledge Transfer of the University of Alicante, Grant Number: GRE-18-17B

The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV

The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI.This work was supported by Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation) (I.P.T., grant numbers UGP-18-242), and the Office of the Vice President of Research and Knowledge Transfer of the University of Alicante (N.R.R. grant numbers GRE-18-17B), and it also has been partially supported by the SPANISH AIDS Research Network RD16/0025/0037 project as part of the Plan Nacional R+D+I

Neurocognitive Functioning and Suicidal Behavior in Violent Offenders with Schizophrenia Spectrum Disorders

Suicide is one of the main premature causes of death in patients with schizophrenia. However, little is known about the relationship between neurocognitive functioning and suicidality in violent offenders with schizophrenia who have been sentenced to psychiatric treatment after committing violent crimes. We examined the neurocognitive functioning of a sample of 61 violent offenders, most of them murderers with schizophrenia who were classified as suicide attempters (n = 26) and non-attempters (n = 35). We compared the neurocognitive functioning of both groups using a neuropsychological battery. Suicide attempters showed similar performance to non-attempters in a neuropsychological test across all domains of cognitive functioning, memory, attention, verbal fluency, and executive functioning. However, after controlling for demographic and clinical variables, suicide attempters performed better than non-attempters in two planning-related tasks: the Tower of London (p < 0.01) and the Zoo Map (p < 0.01). Suicide attempters were also characterized as having more family histories of suicidality and as displaying more depressive symptoms and negative symptoms of psychopathology on the Positive and Negative Syndrome Scale (PANSS) scale. These results suggest that suicide attempters have a greater ability to formulate plans and initiate goals directed at making a suicide attempt.This research was funded by Universidad de Alicante. Vicerrectorado de Investigación y Transferencia del Conocimiento. Proyectos Emergentes. Project number: GRE-19-17. Marcadores Neurocognitivos de Comportamientos Suicidas y Homicidio en delincuentes Violentos con Esquizofrenia

Effectiveness of the TEI Program for Bullying and Cyberbullying Reduction and School Climate Improvement

The increase in the prevalence of bullying and cyberbullying in recent years worldwide is undeniable. Although several intervention programs oriented towards the reduction of bullying and cyberbullying have been developed and implemented, significant disparities have been found regarding their efficacy. In most of the cases, the lack of the implementation of interventions involving all of the school community could be on the basis of this limited efficacy. The present study aimed to evaluate the effectiveness of the TEI Program, an intervention based on peer tutoring, in the reduction of bullying and cyberbullying, and in the improvement of school climate. The design of the study was quasi-experimental, in which 2057 Spanish students (aged 11 to 16 years) participated from 22 schools, and were randomly assigned to the experimental group (10 schools, 987 students) or the control group (12 schools, 1070 students). The obtained results showed a significant reduction in bullying behavior, peer victimization, fighting, cyberbullying and cybervictimization in the experimental group after the intervention implementation. Similarly, a significant improvement in factors of school climate was found only in this group. The obtained results demonstrated that the TEI program is effective in reducing bully and cyberbully behavior, and at the same time, improving the school climate.This study was funded by the Office of the Vice President of Research and Knowledge Transfer of the University of Alicante (GRE-16-32)

Differences in Autonomy and Health-Related Quality of Life between Resilient and Non-Resilient Individuals with Mild Cognitive Impairment

The dramatic increase in the number of older people with Mild Cognitive Impairment (MCI) entails a serious public health problem. MCI involves different degrees of dependence that has been previously related to a decrease in Health-Related Quality of Life (HRQoL), due to impairment in the performance of activities of daily living. Resilient coping, as an adaptive coping style, could reduce the associated limitations derived by the characteristic deficits of MCI, and hence improve HRQoL. The principal objective of this work was to compare the level of autonomy (measured in terms of independence in the performance of basic (ADL) and instrumental (IADL) activities of daily living), and HRQoL between resilient and non-resilient individuals with MCI. The results showed a positive relationship between resilience, autonomy, and HRQoL. Hence, resilient participants exhibited higher independence in daily living activities and better HRQoL than non-resilient individuals. Mediation analyses confirmed an indirect influence of resilience on HRQoL through the mediation effect of better performance in IADLs. These findings underline the relevance of resilience as a coping style to compensate deficits in daily living in people with MCI. The inclusion of intervention programs, oriented to the promotion of resilience coping for older adults, might increase the autonomy levels in this population, improving their HRQoL.This research was supported by the Program of Networks-I3CE of Investigation in University Teaching (Program Networks) from the Vice-Rectorate of Quality and Educational Innovation and Education Sciences Institute of the University of Alicante (2017–2018). Ref.: (4253)