Makindo Medical Notes

Related Subjects: |Dementias |AIDS (HIV) Neurological Disease |AIDS (HIV) Respiratory disease |AIDS Dementia Complex (HIV) |AIDS HIV Infection |AIDS(HIV) Gastrointestinal Disease |Acute Retroviral Syndrome (HIV) |HIV and Post-Exposure Prophylaxis (PEP) |HIV and Pre-exposure prophylaxis |HIV associated nephropathy (HIVAN) |HIV disease Assessment

Early stages of HIV-associated neurocognitive disorders (HAND) may cause a lack of sexual inhibition and lead to more risky behaviors, such as unprotected sex.

About

• HIV-associated dementia (HAD) is rare when anti-retroviral therapy (HAART) is effectively used.

Aetiology

• The virus may enter the brain via HIV-infected macrophages and lymphocytes.
• When CD4+ lymphocyte counts fall below 200 cells/mL, the risk increases.
• HIV infection of glial and neuronal cells leads to damage.
• Pathology often shows damage in the basal ganglia, subcortical regions, and the frontal cortex.

Clinical Features

• Gradual onset of progressive cognitive impairment.
• Personality changes, psychomotor slowing, and depression may occur.
• Patients may also experience psychosis in later stages.

Differential Diagnoses

• CNS lymphoma, which can present similarly.
• Vascular dementia.
• Creutzfeldt-Jakob disease (CJD) in younger patients.

Investigations

• FBC: WCC may be reduced. Perform HIV test, measure CD4 count and viral load.
• Check U&E, LFT, TFT, B12, folate, and glucose levels.
• CT scan in advanced disease may show hypoattenuation areas.
• MRI: Typically shows subcortical white matter disease.
• EEG: May show encephalopathic changes.
• Lumbar puncture for CSF analysis:
  • Raised CSF beta-2 microglobulin.
  • Elevated protein levels in 60% of cases.
  • Elevated IgG in 80% of cases.
  • Oligoclonal bands may be present.
  • CSF is usually acellular, but mononuclear pleocytosis is found in 25% of cases.
  • HIV antibodies may be detected in CSF.

Staging of HIV-associated Dementia (HAD)

Management

• Referral to an HIV specialist for the initiation of HAART is critical. HAART has been shown to reduce the progression of cognitive impairment.

References

• For more information, refer to updated clinical guidelines on HIV and dementia management.