Epidemiology of Neuromuscular Manifestations in Patients Carrying the Hiv Virus in Brazil

Review Article

Austin Virol and Retrovirology. 2023; 5(1): 1028.

Epidemiology of Neuromuscular Manifestations in Patients Carrying the Hiv Virus in Brazil

Karina Lebeis Pires1*; Oswaldo JM Nascimento2; kai-Uwe Lewandrowski3; Max Ramos4*

1Professor of Neurology, Federal University of the State of Rio de Janeiro, Coordinator of the Rare Neuromuscular Diseases Ambulatory at HUGG, Brazil

2Full Professor of Neurology at the Fluminense Federal University, Brazil

3Professor Honoris Causa, Federal University of the State of Rio de Janeiro, Coordinator of the Spine Care Center and Surgery Institute of Tucson, Arizona, USA

4Full Professor and Head of Orthopedics, Federal University of the State of Rio de Janeiro, Brazil

*Corresponding author: Karina Lebeis Pires Professor of Neurology at the Federal University of the State of Rio de Janeiro and Coordinator of the Rare Neuromuscular Diseases Ambulatory at HUGG. Max Ramos, Full Professor and Head of Orthopedics at the Federal University of the State of Rio de Janeiro. Email: drmaxramos@hotmail.com, karinalebeis2@gmail.com

Received: July 26, 2023 Accepted: August 23, 2023 Published: August 30, 2023

Summary

The present study aims to present and discuss epidemiological aspects of the distribution of neurological signs and symptoms in HIV-positive patients treated with Anti Retro Viral ARV therapy in Brazil.

HIV infection has been challenging health authorities since the 1980s. In Brazil, 1,045,355 cases of Acquired Immunodeficiency Syndrome (AIDS) were identified from 1980 to June 2021. According to the Ministry of Health (MS), there has been a 35.7% reduction in the AIDS detection rate since 2012. Even so, 32,701 new cases were detected in 2 020. The most frequent neurological manifestations can be divided into: Inflammatory demyelinating polyradiculoneuropathy, Mononeuropathy and mononeuropathy multiplex, Radiculopathy, Myopathy and diseases of the neuromuscular junction,Motor neuron disease, HIV-associated sensory neuropathy, HIV-associated sensory neuropathy.

Many advances have been observed in recent years regarding the diagnosis and treatment of infection by this virus, however, it remains an important public health problem.

Keywords: HIV; Neuropathy; Epidemiology

Introduction

HIV infection has been challenging health authorities since the 1980. In Brazil, 1,045,355 cases of Acquired Immunodeficiency Syndrome (AIDS) were identified from 1980 to June 2021. According to the Ministry of Health (MS), there has been a 35.7% reduction in the AIDS detection rate since 2012. Even so, 32,701 new cases were detected in 2 020 (MINISTRY OF HEALTH., 2021) [1]. Many advances have been observed in recent years regarding the diagnosis and treatment of infection by this virus, however, this remains an important public health problem.

In 2014, with the inclusion of HIV infection in the list of notifiable diseases, there was a better understanding of the epidemiological profile, allowing the redirection of public health policies. In 2015, there was a 42.3% drop in mortality compared to 1995 (MINISTÉRIO DA SAÚDE., 2017). Of the cases notified until 2021, 43.3% were concentrated in the Southeast region, 69.8% in men, 52.9% in individuals aged between 20 and 34 years and 51.7% in black individuals. Of the cases reported in men, 52.1% were related to homosexual exposure, while in women, 86.8% were related to heterosexual exposure [1].

Among the systemic manifestations of HIV infection, neurological impairment has a great impact on morbidity and mortality. and it occurs not only in association with opportunistic diseases but also by direct action of the virus and exposure to Antiretrovirals (ARV). It is estimated that 40 to 70% of patients have both central and peripheral neurological manifestations (BOISSÉ; GILL; POWER, 2008). With the advent of combined Antiretroviral Therapy (ARTVC) there was a reduction in mortality, but the time of exposure to the virus and ARVs increased. Thus, there was a reduction in neurological impairment secondary to opportunistic infections related to states of severe immunosuppression. On the other hand, symptoms associated with the permanence of the virus and exposure to ART, such as peripheral neuropathy, remain the main neurological alterations (BOISSÉ; GILL; POWER, 2008; CHEN et al., 2013; MORGELLO et al., 2004a; PRIOR; SONG; COHEN, 2018 [2-5,7].

Sensory peripheral neuropathy, particularly Distal Symmetrical Polyneuropathy (DSP), has an incidence that varies between 30 and 67% of cases (KAKU; SIMPSON, 2014 [6] and PRIOR; SONG; COHEN, 20185). 012; KAKU; SIMPSON, 20145; THEMISTOCLEOUS et al., 2014 [8].

One of the pathophysiological explanations for peripheral nervous system impairment involves macrophage dysregulation. As a result, there is a release of pro-inflammatory cytokines and predominantly fiber damage. nervous thin (poorly myelinated Iorunmyelinated). The end result of this process is degeneration of distal axons and neuronal loss in the dorsal root ganglion [8].

Despite the still high numbers, the AIDS detection rate has been falling in Brazil in recent years. From 2012 to 2013 there was a decrease in the number of cases of 1.4%, from 2013 to 2014 3.6%, from 2014 to 2015 4.2% and from 2015 to 2016 the reduction was 5.2% (BOLETIM AIDS, 2017) [1].

Figure 1 below represents the identification rate of the number of cases in Brazil by region in 10 years.