Differential Alterations in the Attentional Networks of People Living with HIV and Apathy: Preliminary Results and Pharmacoclinical Impact

Abstract

Objective

The objective was to determine alterations in the care of people living with human immunodeficiency virus (PLHIV) with depressive disorder without and with apathy to determine differential parameters.

Methods

We studied 69 PLHIV, negativized viral load, of both sexes (19 women and 44 men), with depressive disorder (F32.9-DSM IV), 20 with apathy and 26 without apathy; negativized viral load, in highly effective antiretroviral treatment without therapeutic failure in the last 2 years and without protease inhibitors; without psychopharmacological treatment (except anxiolytics) or dementia due to HIV (American Academy of Neurology) or comorbidities (hepatitis C, CNS or central vascular infections). They were evaluated with MINI, Hamilton Depression Rating Scale, Apathy Evaluation Scale clinical version and Neuropsychiatric Inventory and neuropsychological tests were applied (Stroop, Trail Making A and B, digit-symbol substitution test, Visual and verbal direct digit span test, BTS−1 and BTS−3). Statistical tests were applied, and ethical-legal standards were met.

Results

PLHIV with depressive disorder had a high prevalence of apathy. In patients with apathy, there was a greater significant alteration, according to decreasing differential involvement, in sustained and divided care. The processing speed was slowed down without significant difference in the apathy group. Selective attention did not show significant differences between groups.

Conclusions

Apathy in patients living with HIV with depression presents specific and differential alterations in the attention domain. The alterations of sustained and divided attention were specific in this group, with affectation of the previous attention circuit and would be related to the subsequent cognitive disruption as a prodrome. These characteristics must be taken into account as the basis for establishing interdisciplinary treatment strategies (psychopharmacological, psychotherapeutic and neurocognitive rehabilitation).