Al parecer, un aumento de la carga viral, aumenta el riesgo de la intervención directa del sistema nervioso central y el riesgo de desarrollar síntomas de manía con el deterioro cognitivo posterior (154,155,156,157,158,159,160).

En resumen, el reconocimiento precoz y el tratamiento de los síntomas maníacos y la institución de la terapia antirretroviral concomitante puede aumentar las posibilidades de un período más largo de buena salud y disminuir la velocidad a la que se deriva de mortalidad en la enfermedad relacionada con el VIH (161,162,163,164,165).

Conclusión:

Las complicaciones y los trastornos neuropsiquiátricos pueden surgir en cualquier momento durante el curso de la infección por HIV. Desde el punto de vista fisiopatológico las estructuras implicadas en los cuadros psicóticos en los pacientes con HIV-SIDA son: Atrofia infratentorial, central y subcortical, disminución los ganglios basales. Estos hallazgos coinciden por lo general con la presencia de citoquinas a nivel del líquido cefalorraquídeo tales como: el factor de necrosis tumoral, ácido araquidónico, interferón gamma, eicosanoides, proteína tat y nef. Los mecanismos asociados a la patología psiquiátrica son directos como la encefalopatía por HIV o indirecto a través la glucoproteína 120 de la envoltura viral (gp120) derivada del VIH. Aun las quejas neurocomportamentales más sutiles, en personas previamente asintomáticas, imponen una completa evaluación médica y psiquiátrica ya que la presencia de psicosis en los pacientes con HIV son el pródromo de una disfunción neuropsiquiátrica severa y por lo general precede a un aumento importante de la carga viral comportándose como un predictor del inicio de la terapia antirretroviral de ataque.

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