Even in the highly active antiretroviral therapy era, the risk of developing SBM is 19 times higher among HIV-1-infected patients than among uninfected ones. It tends to present in severely immunosuppressed patients not previously vaccinated and off antiretroviral therapy, with a concomitant extrameningeal infection, bacteremia, and focal neurologic signs, and is caused by S. pneumoniae. SBM in HIV-1-infected patients carries a worse prognosis than in uninfected ones both in terms of lethality and sequelae.

Our study suggests similar virological efficacy for efavirenz- or lopinavir/ritonavir-based first-line antiretroviral regimens, but an increased risk of discontinuation because of toxicity in case of lopinavir/ritonavir-based therapy. Immunological outcome appeared similar with both regimens.

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Background People in their fifties with HIV are considered older adults, but they appear not to be a homogeneous group. Objective To evaluate the differences among older adults with HIV according to their chronological age and the year of HIV diagnosis. Methods Cross-sectional study of the FUNCFRAIL cohort. Patients 50 or over with HIV were included and were stratified by both chronological age and the year of HIV diagnosis: before 1996 (long-term HIV survivors [LTHS]) and after 1996. We recorded sociodemographic data, HIV-related factors, comorbidities, frailty, physical function, other geriatric syndromes, and quality of life (QOL). Results We evaluated 801 patients. Of these, 24.7% were women, 47.0% were LTHS, and 14.7% were 65 or over. Of the 65 or over patients, 73% were diagnosed after 1996. Higher rates of comorbidities among LTHS were found, being the more prevalent: COPD, history of cancer, osteoarthritis, depression, and other psychiatric disorders while the more prevalent among the 65 or over patients were: hypertension, diabetes, dyslipidemia, cancer, and osteoarthritis. LTHS showed a significantly worse QOL. There were no differences by the year of HIV diagnosis regarding frailty and functional impairment (SPPB <10) but they were more than twice as prevalent in the 65 or over patients compared to the other chronological age groups. Conclusions A LTHS and a 65 or over person are both “older adults with HIV,” but their characteristics and requirements differ markedly. It is mandatory to design specific approaches focused on the real needs of the different profiles.

Objective: Psychiatric morbidity and psychopathology have been widely assessed in patients with epilepsy. However, the issue of whether people with epilepsy are at increased risk for psychopathology remains highly controversial. These disorders are not evaluated in a systematic manner in patients with non-lesional epilepsy, so they could be underestimated. The objective is to evaluate personality disorders in patients with non-lesional epilepsy. Methods: In this study, we investigated the presence of personality disorders in 63 patients with chronic non-lesional (idiopathic and cryptogenic) epilepsy and in 40 unrelated and randomly selected controls by means of Minnesota Multiphasic Personality Inventory (MMPI) and DSM-IV criteria for the different personality disorders. Results: The overall scores were significantly higher in the patients in the subscales of schizophrenia, depression, hysteria, mania, paranoia, psychasthenia and psychopathic deviate. However, the differences in the proportion of patients with clinically significant scores occurred only for schizophrenia (57 vs. 20%), depression (55 vs. 15%), psychasthenia (28 vs. 10%) and paranoia (14 vs. 0%). According to DSM-IV criteria, only 11 patients met the criteria of schizotypal personality. We found excellent concordance for paranoid personality and depression between the two instruments of diagnosis. However, we did not find cases with either antisocial or avoidant personality. We also found a significant link between poor control of epilepsy and high scores in both paranoia and psychopathic deviate. Conclusions: In comparison with the DSM-IV criteria for such personality disorders, the MMPI was oversensitive in detecting schizotypal features. However, the MMPI correctly classified the remaining personality disorders, especially depression and paranoid personality. On the basis of these results, we conclude that psychopathology is overrepresented in patients with chronic non-lesional epilepsy and that, in determined variables, this is due to the severity of the condition rather than to the type and duration of epilepsy. The approach to patients with chronic epilepsy should include neurobehavioural scales.