eMedicine Specialties > Neurology > Neurological Infections

HIV-1 Encephalopathy and AIDS Dementia Complex: Follow-up

Author: Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Coauthor(s): Sofia Yahya, MD, Staff Physician, Department of Psychiatry, Barnes-Jewish Hospital, Washington University School of Medicine; Mandeep Garewal, MD, Staff Physician, Department of Neurology, Saint Louis University School of Medicine; Florian P Thomas, MD, MA, PhD, DrMed, Associate Chief of Staff, St Louis VA Medical Center; Associate Director, Neurology Residency Program; Professor, Departments of Neurology, Molecular Virology, and Molecular Microbiology and Immunology, Saint Louis University School of Medicine
Contributor Information and Disclosures

Updated: May 8, 2007

Follow-up

Further Inpatient Care

  • Depending on the severity and manifestations of ADC, patients may require nursing home placement.
    • The severely demented and emaciated patient is at risk for decubitus ulcers.
    • Psychotic features of ADC may require psychiatric consultation.
    • Although seizures are rare, their management is difficult, because several antiseizure drugs affect blood levels of antiretroviral drugs.

Further Outpatient Care

  • Patients need close follow-up because of progressive dementia, unavoidable polypharmacy with possibly toxic drug levels (in particular free drug levels), and possible development of seizures and psychosis. Patients may become incapable of self-care and require hospice care.
  • HIV RNA levels and CD4+ T-cell counts should be evaluated periodically to uncover clinical response and treatment resistance. HIV RNA serum levels generally reflect CSF levels until late in disease when different HIV strains may be present.

Prognosis

  • The prognosis is guarded.
  • HAART has reduced the incidence of ADC via suppression and reversal. However, given that HAART may not be completely effective in penetrating the BBB, low levels of HIV may continue to replicate, thereby increasing the incidence of MCMD. Although MCMD may be considered a chronic condition, it may progress to a more severe dementia.
  • Use of HAART has made PHE infrequent and largely reversible. If control of the virus is lost, relapse may occur.
  • In the pre-HAART era, CD4+ counts and HIV RNA load were the best predictors of morbidity and mortality of AIDS. In the post-HAART era, their value has diminished. In a study of 329 patients who were HIV positive with CD4+ counts of less than 200 or less than 300 with ADC, ADC was an independent predictor of time to death.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Misidentifying a clinical presentation as ADC can delay the appropriate treatment of conditions such as toxoplasmosis or cytomegalovirus (CMV) encephalitis.
  • Appropriate treatment may also be delayed by failure to check HIV status in any otherwise young, healthy individual with cognitive, behavioral, and/or motor changes.
 


More on HIV-1 Encephalopathy and AIDS Dementia Complex

Overview: HIV-1 Encephalopathy and AIDS Dementia Complex
Differential Diagnoses & Workup: HIV-1 Encephalopathy and AIDS Dementia Complex
Treatment & Medication: HIV-1 Encephalopathy and AIDS Dementia Complex
Follow-up: HIV-1 Encephalopathy and AIDS Dementia Complex
Multimedia: HIV-1 Encephalopathy and AIDS Dementia Complex
References
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References

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Further Reading

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Keywords

AIDS dementia complex, ADC, HIV-1–associated cognitive/motor complex, AIDS encephalopathy, HIV encephalopathy, subacute HIV encephalitis, HIV-associated dementia complex, AIDS-related dementia, HIV dementia, acquired immunodeficiency syndrome, AIDS, human immunodeficiency virus, HIV, minor cognitive motor disorder, MCMD, highly active antiretroviral therapy, HAART

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Contributor Information and Disclosures

Author

Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Niranjan N Singh, MD, DNB is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Sofia Yahya, MD, Staff Physician, Department of Psychiatry, Barnes-Jewish Hospital, Washington University School of Medicine
Sofia Yahya, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Mandeep Garewal, MD, Staff Physician, Department of Neurology, Saint Louis University School of Medicine
Mandeep Garewal, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, and American Society of Neuroimaging
Disclosure: Nothing to disclose.

Florian P Thomas, MD, MA, PhD, DrMed, Associate Chief of Staff, St Louis VA Medical Center; Associate Director, Neurology Residency Program; Professor, Departments of Neurology, Molecular Virology, and Molecular Microbiology and Immunology, Saint Louis University School of Medicine
Florian P Thomas, MD, MA, PhD, DrMed is a member of the following medical societies: American Academy of Neurology and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Medical Editor

Michael J Schneck, MD, Associate Professor, Department of Neurology and Neurosurgery, Loyola University Chicago, Stritch School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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