Demencia asociada al VIH: desafíos diagnósticos actuales e implicaciones para la atención integral. Revisión narrativa
Barra lateral del artículo
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
La publicación se distribuye bajo la Licencia Creative Commons Atribución- 4.0 Internacional (CC BY 4.0). Los derechos de los trabajos publicados en esta revista son propiedad del autor, los cuales son libres de distribuir y difundir las mismas, siempre que cite correctamente la fuente.
Cómo citar
Contenido principal del artículo
Resumen
Introducción: La demencia asociada al virus de la inmunodeficiencia humana (VIH) ha disminuido en la era de la terapia antirretroviral, pero su diagnóstico y atención presentan nuevos desafíos ante el envejecimiento, la multimorbilidad y la diversidad de causas de deterioro cognitivo en las personas que viven con VIH. Objetivo: Caracterizar la demencia asociada al VIH en el contexto actual, de acuerdo con sus aspectos clínicos, neurocognitivos y psicosociales, así como los desafíos para su diagnóstico y la atención integral. Métodos: Se realizó una revisión narrativa orientada por los criterios SANRA. La búsqueda se efectuó entre abril y agosto de 2026 en PubMed/MEDLINE, Scopus, Web of Science y Embase, con publicaciones comprendidas principalmente entre enero de 2022 y agosto de 2026; se incluyeron 30 publicaciones en la síntesis. Resultados: La evidencia muestra una reducción de las formas graves de deterioro neurocognitivo, junto con una creciente complejidad para atribuir causalmente la demencia al VIH. Los criterios de Frascati continúan como referente para la investigación, aunque sus limitaciones han motivado propuestas contemporáneas que conceden mayor importancia a la trayectoria clínica, la funcionalidad y la diferenciación de otras etiologías. Las herramientas breves de cribado no sustituyen la evaluación neuropsicológica, funcional y etiológica. La atención requiere integrar control virológico, comorbilidades, salud mental, rehabilitación y apoyos familiares y sociales mediante coordinación interdisciplinaria. La evidencia específica sobre demencia asociada al VIH permanece limitada frente a la disponible sobre deterioro neurocognitivo general y presenta heterogeneidad diagnóstica y geográfica. Conclusiones: La demencia asociada al VIH es actualmente menos frecuente, pero su reconocimiento y atención exigen una valoración individualizada, multidimensional e interdisciplinaria.
Referencias
[1] Cysique LA, Levin J, Howard C, Taylor J, Rule J, Costello J, et al. Fostering healthy cognitive ageing in people living with HIV. Lancet HIV. 2025;12(1):e71-e80. DOI: https://doi.org/10.1016/S2352-3018(24)00248-0
[2] Nolasco M, Pokala SS, Saavedra Forero LM, Cuevas J, Koble JM, Conklin JL, et al. Risk factors for HIV-associated neurocognitive impairment and frailty in aging people with HIV in Latin America: a systematic review. BMC Neurol. 2026;26:312. DOI: https://doi.org/10.1186/s12883-026-04767-y
[3] Mastrorosa I, Pinnetti C, Brita AC, Mondi A, Lorenzini P, Del Duca G, et al. Declining prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorders in recent years and associated factors in a large cohort of antiretroviral therapy-treated individuals with HIV. Clin Infect Dis. 2023;76(3):e629-e637. DOI: https://doi.org/10.1093/cid/ciac658
[4] Lee E, Lee YG, Bang J. Risk factors associated with incident dementia in people living with HIV. J Korean Med Sci. 2025;40(22):e100. DOI: https://doi.org/10.3346/jkms.2025.40.e100
[5] Nightingale S, Ances B, Cinque P, Dravid A, Dreyer AJ, Gisslén M, et al. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol. 2023;19(7):424-433. DOI: https://doi.org/10.1038/s41582-023-00813-2
[6] Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019;4:5. DOI: https://doi.org/10.1186/s41073-019-0064-8
[7] Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69(18):1789-1799. DOI: https://doi.org/10.1212/01.WNL.0000287431.88658.8b
[8] Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, et al. Global prevalence and burden of HIV-associated neurocognitive disorder: a meta-analysis. Neurology. 2020;95(19):e2610-e2621. DOI: https://doi.org/10.1212/WNL.0000000000010752
[9] Ru W, Tang SJ. HIV-associated synaptic degeneration. Mol Brain. 2017;10(1):40. DOI: https://doi.org/10.1186/s13041-017-0321-z
[10] Cornea A, Lata I, Simu M, Rosca EC. Assessment and diagnosis of HIV-associated dementia. Viruses. 2023;15(2):378. DOI: https://doi.org/10.3390/v15020378
[11] Weber MT, Finkelstein A, Uddin MN, Reddy EA, Arduino RC, Wang L, et al. Longitudinal effects of combination antiretroviral therapy on cognition and neuroimaging biomarkers in treatment-naive people with HIV. Neurology. 2022;99(10):e1045-e1055. DOI: https://doi.org/10.1212/WNL.0000000000200829
[12] Henderson M, Winston A. Risk factors for cognitive decline in persons with HIV. Curr Opin Infect Dis. 2025;38(1):37-43. DOI: https://doi.org/10.1097/QCO.0000000000001080
[13] Ellis RJ, Paolillo EW, Saloner R, Heaton RK. Higher comorbidity burden predicts worsening neurocognitive trajectories in people with human immunodeficiency virus. Clin Infect Dis. 2022;74(8):1323-1328. DOI: https://doi.org/10.1093/cid/ciab655
[14] Lam JO, Hou CE, Gilsanz P, Lee C, Lea AN, Satre DD, et al. Undiagnosed cognitive impairment and impact on instrumental activities of daily living among people with HIV infection in primary care. Open Forum Infect Dis. 2023;10(6):ofad284. DOI: https://doi.org/10.1093/ofid/ofad284
[15] Zipursky AR, Gogolishvili D, Rueda S, Brunetta J, Carvalhal A, McCombe JA, et al. Evaluation of brief screening tools for neurocognitive impairment in HIV/AIDS: a systematic review of the literature. AIDS. 2013;27(15):2385-2401. DOI: https://doi.org/10.1097/QAD.0b013e328363bf56
[16] Kelly CM, Nightingale S, Gupta RK, Collier DA. HIV cerebrospinal fluid escape: interventions for the management, current evidence and future perspectives. Trop Med Infect Dis. 2025;10(2):45. DOI: https://doi.org/10.3390/tropicalmed10020045
[17] Alford K, Banerjee S, Daley S, Hamlyn E, Trotman D, Vera JH. Health-related quality of life in people living with HIV with cognitive symptoms: assessing relevant domains and associations. J Int Assoc Provid AIDS Care. 2023;22:23259582231164241. DOI: https://doi.org/10.1177/23259582231164241
[18] Wang CX, Chentsova VO, Prescott MR, Umlauf A, Moore DJ, Ellis RJ, et al. Independent and combined adverse effects of neurocognitive impairment and depression on everyday functioning and quality of life in people with HIV. J Int Neuropsychol Soc. 2025;31(2):147-156. DOI: https://doi.org/10.1017/S1355617725000153
[19] Britton MK, Lembo M, Li Y, Porges EC, Cook RL, Cohen RA, et al. HIV stigma is associated with two-year decline in cognitive performance among people with HIV. AIDS Behav. 2025;29(1):90-100. DOI: https://doi.org/10.1007/s10461-024-04508-7
[20] Yoo-Jeong M, Nguyen AL. Combined effects of social isolation and loneliness on patient-reported outcomes in older adults with HIV. AIDS Care. 2024;36(9):1325-1332. DOI: https://doi.org/10.1080/09540121.2024.2339046
[21] Yoo-Jeong M, Dastgheyb RM, Shorer EF, Demsky C, Fox O, Inaganti D, et al. Emotional loneliness is related to objective cognitive function in older people with HIV in the Washington-Baltimore area: a cross-sectional study. J Assoc Nurses AIDS Care. 2024;35(6):519-529. DOI: https://doi.org/10.1097/JNC.0000000000000491
[22] Gervolino SC, Krause KD, Halkitis PN. The role of social support networks in a sample of older adults living with HIV: the GOLD studies. AIDS Care. 2024;36(9):1302-1309. DOI: https://doi.org/10.1080/09540121.2024.2312877
[23] Damas J, Darling KEA, Bidlingmeyer P, Nadin-Debluë I, Bieler M, Vollino L, et al. One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV. HIV Med. 2023;24(6):738-748. DOI: https://doi.org/10.1111/hiv.13472
[24] Fischer EL, Renaud A, Grivaz P, Di Liberto G, Ryvlin P, Cavassini M, et al. Advances in assessment and cognitive neurorehabilitation of HIV-related neurocognitive impairment. Brain Commun. 2025;7(1):fcae399. DOI: https://doi.org/10.1093/braincomms/fcae399
[25] Desai R, Vera J, Barber T, Alford K, Tanner C, Kothari K, et al. Effectiveness of interventions on cognitive decline risk for people living with HIV on antiretroviral therapy: a systematic review. Lancet Healthy Longev. 2026;7(4):100849. DOI: https://doi.org/10.1016/j.lanhl.2026.100849
[26] Stuart L, Alford K, Vera JH. Non-pharmaceutical interventions for people living with HIV with cognitive impairment: A scoping review. PLoS One. 2024;19(11):e0314185. DOI: https://doi.org/10.1371/journal.pone.0314185
[27] Moschopoulos CD, Alford K, Antoniadou A, Vera JH. Cognitive impairment in people living with HIV: mechanisms, controversies, and future perspectives. Trends Mol Med. 2024;30(11):1076-1089. DOI: https://doi.org/10.1016/j.molmed.2024.06.005
[28] Heaton RK, Ellis RJ, Tang B, Marra CM, Rubin LH, Clifford DB, et al. Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study. Brain. 2023;146(3):1121-1131. DOI: https://doi.org/10.1093/brain/awac465
[29] Aung HL, Bloch M, Vincent T, Mao L, Brew BJ, Cysique LA. Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study. J Neurovirol. 2023;29(2):141-155. DOI: https://doi.org/10.1007/s13365-022-01104-0
[30] Ostermann PN, Evering TH. The impact of aging on HIV-1-related neurocognitive impairment. Ageing Res Rev. 2024;102:102513. DOI: https://doi.org/10.1016/j.arr.2024.102513
[31] Mustafa M, Musselman D, Jayaweera D, da Fonseca Ferreira A, Marzouka G, Dong C. HIV-associated neurocognitive disorder (HAND) and Alzheimer’s disease pathogenesis: future directions for diagnosis and treatment. Int J Mol Sci. 2024;25(20):11170. DOI: https://doi.org/10.3390/ijms252011170