Avaliação das características neuropsicológicas, comportamentais e de desempenho escolar em uma amostra de infanto juvenis infectados pelo HIV verticalmente

Abstract

The changes in cognitive and behavioral functioning within the studies of infection by HIV is a concern since the epidemic began. The development and popularization of combinade antiretroviral therapy (HAART) is an important epidemiological transition in HIV studies. The implementation of HAART dramatically reduces mortality and disease progression; however their contributions to the reduction of cognitive impairments are not yet clear. Most studies show positive effects cognitive functioning, but this relationship is not yet fully elucidated in the literature. After the implementation of HAART, the focus of studies related to neuropsychology of HIV is being concentrated on finding neuropsychological deficits directly linked to HIV; determining if the deficit is associated with comorbid conditions (e.g. psychiatric disease, nutritional deficiencies, drugs, hepatitis C, treatment side effects..); explore the relationship between neuropsychological deficits and disease variables (CD4 count, HIV biomarkers and neuroimaging tests); and explore the relationship between neuropsychological impairment and behavior. The changes are manifested throughout the development and are presented by a pattern of non-specific damage, affecting both the behavior and cognition. The cognitive point of view, the changes are manifested by related losses, especially in executive function and processing speed. Other cognitive functions are also affected as language, intelligence, memory, attention, motor skills, and visuospatial processing. In order to investigate which neuropsychological characteristics, behavioral and academic performance were establishedtwo objectives to be developed in this thesis: 1) What are the most neuropsychological impairments observed in juvenile childhood population infected with HIV; 2) What are the neuropsychologicalcharacteristics, behavioral and academic performance in a sample of infected juvenile childhood vertically HIV. In study I, it is carried out a literature review on the neuropsychological characteristics of children, adolescents and young adults (age <24 years), the commitment patternsobserved and the main cognitive functions assessed. The results showed that the cognitive domains most investigated in HIV neuropsychology are intelligence, executive function, attention, memory,processing speed and motor skills. Overall, the results show that the performance of HIV infected participants is less than the uninfected population. The losses are the most prominent as the evolutionparameters of the disease progressing. In Study II a comprehensive neuropsychological assessment was conducted, with 50 participants between 8 and 22 years of age on tasks that assessed intelligence, executive function, attention, motor skills, memory and school performance. The results showed worse performance in the group with greater progression of the disease (AIDS group) compared with participants in the infected group, but in early stages (HIV group) and the control group. The study III explores the behavioral characteristics in a sample of young people infected with HIV vertically on a standardized questionnaire answered by parents. The results show that nobehavioral changes were observed in groups investigated compared with population norms. The work is further evidence of the benefits that HAART produces in maintaining cognitive and behavioral aspects, since the observed losses are significantly lower than those reported in previous literature to open access promoted by the brazilian government from the year 1996. In addition, the cognitive impairments are subtle and more prominent in the group in later stages of infection