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AIDS dementia complex; AIDS encephalopathy; HIV-associated dementia (HAD)
Pathology:
1) cerebral cortical atrophy, neuronal loss
2) microglial nodules/multinucleated giant cells
3) reactive astrocytosis
4) elevated TNF-alpha mRNA in microglia & astrocytes
5) implicated proteins: APLNR
Clinical manifestations:
1) features of subcortical dementia
a) apathy
b) psychomotor retardation
c) difficulty with retrieval
d) motor dysfunction
2) features of cortical dementia may co-exist
3) impaired concentration
4) forgetfulness
5) personality changes
6) withdrawal
7) agitation, irritability, confusion & psychosis are rare
8) with progessive dementia
a) impaired rapid movements
b) hyper-reflexia
c) release reflexes
d) weakness
e) ataxia
f) spasticity
g) bowel & bladder incontinence
h) myoclonus
Laboratory:
-> cerebrospinal fluid
a) mildly elevated protein
b) mild pleocytosis with predominance of mononuclear cells
Radiology:
1) computed tomography (CT): cerebral atrophy
2) magnetic resonance imaging (MRI):
- patchy or diffusely increased signal intensity in white matter & less frequently basal ganglia or thalamus
Differential diagnosis:
- progressive multifocal leukoencephalopathy (PML)
- other opportunistic CNS infections in HIV infection include
- CMV encephalitis and ventriculitis
- cryptococcal meningitis
- cerebral toxoplasmosis
- cerebral nocardiosis
- tuberculous meningitis
- meningeal neurosyphilis
Management:
- antiretroviral therapy (see HIV1 infection Management:)
- antiretroviral therapy is likely to improve dementia
- some HIV1-associated cognitive deficits will remain
- sooner initiation of antiretroviral therapy increases likelihood of improving cognitive function [4]
- extensive neuropathology prior to initiation of therapy portends worse outcome
from references [1,2,4]
- zidovudine (AZT)
a) may be helpful in preventing occurrence
b) may partially reverse symptoms in patients with established dementia
c) high dose
Interactions
disease interactions
General
neurodegenerative disease
viral encephalitis
Properties
PATHOLOGY: microglial nodule
SITE: brain
atrophy
TISSUE: cerebral cortex
ETIOLOGY: human immunodeficiency virus-1
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Kaul et al. Pathways to neuronal injury and apoptosis in
HIV-associated dementia. Nature 410:988-94 2001 [review]
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Heaton RK, Clifford DB, Franklin DR Jr et al
HIV-associated neurocognitive disorders persist in the era of potent
antiretroviral therapy: CHARTER Study.
Neurology. 2010 Dec 7;75(23):2087-96.
PMID: 21135382 Free PMC article.
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