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NeuroAIDS: a watershed for mental health and nervous system disorders.

2009; National Institutes of Health; Linguagem: Inglês

Jennifer A. McCombe, Farshid Noorbakhsh, Craig Buchholz, Michael Trew, Christopher Power,

Tryptophan and brain disorders

More than 15% of the world's burden of disease is attributable to interlocking neurologic and psychiatric (neuropsychiatric) disorders; these syndromes include mood disorders, schizophrenia, addiction, dementia, epilepsy and chronic pain disorders.1 Neuropsychiatric disorders associated with HIV infection represent the convergence of a major global infectious epidemic with nervous system disease, resulting in substantial morbidity and mortality, especially as the disease progresses to AIDS. HIV directly infects and injures the central and peripheral nervous systems, culminating in a wide spectrum of neuropsychiatric disorders (collectively termed neuroAIDS), including neurocognitive disorders such as HIV-associated dementia, minor neurocognitive disorder, mania/psychosis, anxiety, depression, seizures, and myelopathy and neuropathy with accompanying chronic neuropathic pain and physical disabilities (Fig. 1). In fact, HIV entry into the nervous system (neuroinvasion) occurs early after primary infection but persists throughout the disease course because the virus chronically infects glial cells (neurotropism) and has ensuing potential for nervous system disease (neurovirulence). However, only a subset of people with HIV exhibit nervous system disease, indicating selective vulnerability to a neuropsychiatric phenotype (neurosusceptiblity) caused by HIV, defined by age, level of concurrent immunosuppression, comorbidities and both host and virus genetic diversities.2 These neuropsychiatric disorders are associated with diminished quality of life,3 increased health care costs4 and reduced survival.5 Several of these disorders are also apparent in children with HIV who also have developmental delay.6 In addition, systemic immunosuppression increases the risk, particularly among adults, of opportunistic processes within the nervous system, including progressive multifocal leukoencephalopathy, toxoplasmic encephalitis, cryptococcal and tuberculous meningitis and primary central nervous system lymphoma associated with seizures, physical and cognitive disabilities, psychosis and mood disorders.