eMedicine Specialties > Psychiatry > Psychosomatic

Dementia Due to HIV Disease: Multimedia

Author: Soma Sahai-Srivastava, MD, Director of Neurology Ambulatory Care Services, LAC and USC Medical Center; Assistant Professor, Department of Neurology, University of Southern California
Coauthor(s): Arousiak Varpetian, MD, Assistant Professor of Clinical Neurology, Department of Neurology, University of Southern California Keck School of Medicine; Clinical Director, Rand Schrader Neurology Clinic (Los Angeles County-University of Southern California HIV Clinic)
Contributor Information and Disclosures

Updated: Jan 2, 2009

Multimedia

A 40-year-old woman presented with confusion, dec...
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Media file 1: A 40-year-old woman presented with confusion, decline in memory without any focal findings, and dehydration. She was diagnosed with HIV 3 months prior and started on HAART medication 1 month prior when she had no cognitive symptoms. The MRI shows atrophy and white matter hyperintensity on T2 not involving U-fibers. CSF studies were negative for demyelinating disease, JC virus DNA, cryptococcal antigen, and CMV IgG and IgM. Confusion eventually improved with hydration, but on follow-up 2 months later, she still had significant cognitive deficits and needed assistance from family in instrumental activities of daily living.
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A 40-year-old woman presented with confusion, dec...

A 40-year-old woman presented with confusion, decline in memory without any focal findings, and dehydration. She was diagnosed with HIV 3 months prior and started on HAART medication 1 month prior when she had no cognitive symptoms. The MRI shows atrophy and white matter hyperintensity on T2 not involving U-fibers. CSF studies were negative for demyelinating disease, JC virus DNA, cryptococcal antigen, and CMV IgG and IgM. Confusion eventually improved with hydration, but on follow-up 2 months later, she still had significant cognitive deficits and needed assistance from family in instrumental activities of daily living.

A 22-year-old woman who was infected with HIV fro...
(Enlarge Image)
Media file 2: A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.
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A 22-year-old woman who was infected with HIV fro...

A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.

A 22-year-old woman who was infected with HIV fro...
(Enlarge Image)
Media file 3: A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.
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A 22-year-old woman who was infected with HIV fro...

A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.

A 22-year-old woman who was infected with HIV fro...
(Enlarge Image)
Media file 4: A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.
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A 22-year-old woman who was infected with HIV fro...

A 22-year-old woman who was infected with HIV from a perinatal blood transfusion, presented with bilateral leg weakness. Brain MRI showed atrophy and minimal white matter hyperintensity. Thoracic and lumbar MRI showed no abnormalities. The radiological diagnosis was HIV-encephalitis. The weakness in the legs did not change over the next 4 years. Despite treatment with HAART, cognitive changes developed 4 years later. The patient died of intracranial hemorrhage due to blood dyscrasia at the age of 25.

Candida, GMS stain.
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Media file 5: Candida, GMS stain.
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Candida, GMS stain.

Candida, GMS stain.

Cerebritis.
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Media file 6: Cerebritis.
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Cerebritis.

Cerebritis.

Pontine hemorrhage.
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Media file 7: Pontine hemorrhage.
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Pontine hemorrhage.

Pontine hemorrhage.

Spinal cord infarction.
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Media file 8: Spinal cord infarction.
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Spinal cord infarction.

Spinal cord infarction.

More on Dementia Due to HIV Disease

Overview: Dementia Due to HIV Disease
Differential Diagnoses & Workup: Dementia Due to HIV Disease
Treatment & Medication: Dementia Due to HIV Disease
Follow-up: Dementia Due to HIV Disease
Multimedia: Dementia Due to HIV Disease
References
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References

  1. Ances BM, Ellis RJ. Dementia and neurocognitive disorders due to HIV-1 infection. Semin Neurol. Feb 2007;27(1):86-92. [Medline].

  2. UNAIDS and WHO. 2007 AIDS epidemic update. UNAIDS. Available at http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf. Accessed 3/25/08.

  3. Navia BA. Clinical and biologic features of the AIDS dementia complex. Neuroimaging Clin N Am. Aug 1997;7(3):581-92. [Medline].

  4. Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology. Jun 1991;41(6):778-85. [Medline].

  5. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. Oct 30 2007;69(18):1789-99. [Medline].

  6. Brabers NA, Nottet HS. Role of the pro-inflammatory cytokines TNF-alpha and IL-1beta in HIV-associated dementia. Eur J Clin Invest. Jul 2006;36(7):447-58. [Medline].

  7. Garden GA, Morrison RS. The multiple roles of p53 in the pathogenesis of HIV associated dementia. Biochem Biophys Res Commun. Jun 10 2005;331(3):799-809. [Medline].

  8. Nardacci R, Antinori A, Kroemer G, Piacentini M. Cell death mechanisms in HIV-associated dementia: the involvement of syncytia. Cell Death Differ. Aug 2005;12 Suppl 1:855-8. [Medline].

  9. Di Rocco A, Werner P. Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry. Apr 1999;66(4):554. [Medline].

  10. Swingler S. Pathogenic mechanisms of neuronal damage in the AIDS dementia complex. Mol Pathol. Apr 1997;50(2):72-6. [Medline].

  11. Tan SV, Guiloff RJ. Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry. Jul 1998;65(1):23-8. [Medline].

  12. McArthur JC. HIV dementia: an evolving disease. J Neuroimmunol. Dec 2004;157(1-2):3-10. [Medline].

  13. Sacktor N, Lyles RH, Skolasky R, Kleeberger C, Selnes OA, Miller EN, et al. HIV-associated neurologic disease incidence changes:: Multicenter AIDS Cohort Study, 1990-1998. Neurology. Jan 23 2001;56(2):257-60. [Medline].

  14. Goodkin K, Aronow A, Baldwin G, Molina R, Zheng, W, et al. HIV-1 associated neurocognitive disorders in the HAART era. In: The Spectrum of Neuro-AIDS Disorders. Washington DC: ASM Press; 2008.

  15. Wohl DA, Zeng D, Stewart P, Glomb N, Alcorn T, Jones S. Cytomegalovirus viremia, mortality, and end-organ disease among patients with AIDS receiving potent antiretroviral therapies. J Acquir Immune Defic Syndr. Apr 15 2005;38(5):538-44. [Medline].

  16. Stern Y, McDermott MP, Albert S, Palumbo D, Selnes OA, McArthur J. Factors associated with incident human immunodeficiency virus-dementia. Arch Neurol. Mar 2001;58(3):473-9. [Medline].

  17. Liu X, Marder K, Stern Y, Dooneief G, Bell K, Todak G. Gender Differences in HIV-Related Neurological Progression in a Cohort of Injecting Drug Users Followed for 3.5 Years. J NeuroAIDS. 1996;1(4):17-30. [Medline].

  18. Farinpour R, Miller EN, Satz P, Selnes OA, Cohen BA, Becker JT. Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. Aug 2003;25(5):654-70. [Medline].

  19. Becker JT, Lopez OL, Dew MA, Aizenstein HJ. Prevalence of cognitive disorders differs as a function of age in HIV virus infection. AIDS. Jan 1 2004;18 Suppl 1:S11-8. [Medline].

  20. Skolnick AA. Protease inhibitors may reverse AIDS dementia. JAMA. Feb 11 1998;279(6):419. [Medline].

  21. Blanch J, Martínez E, Rousaud A, Blanco JL, García-Viejo MA, Peri JM. Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz. J Acquir Immune Defic Syndr. Aug 1 2001;27(4):336-43. [Medline].

  22. Vendrely A, Bienvenu B, Gasnault J, Thiebault JB, Salmon D, Gray F. Fulminant inflammatory leukoencephalopathy associated with HAART-induced immune restoration in AIDS-related progressive multifocal leukoencephalopathy. Acta Neuropathol. Apr 2005;109(4):449-55. [Medline].

  23. Lee PL, Yiannoutsos CT, Ernst T, Chang L, Marra CM, Jarvik JG, et al. A multi-center 1H MRS study of the AIDS dementia complex: validation and preliminary analysis. J Magn Reson Imaging. Jun 2003;17(6):625-33. [Medline].

  24. Chang L, Lee PL, Yiannoutsos CT, Ernst T, Marra CM, Richards T, et al. A multicenter in vivo proton-MRS study of HIV-associated dementia and its relationship to age. Neuroimage. Dec 2004;23(4):1336-47. [Medline].

  25. Chang L, Ernst T, Leonido-Yee M, Walot I, Singer E. Cerebral metabolite abnormalities correlate with clinical severity of HIV-1 cognitive motor complex. Neurology. Jan 1 1999;52(1):100-8. [Medline].

  26. Glass JD, Wesselingh SL. Viral load in HIV-associated dementia. Ann Neurol. Jul 1998;44(1):150-1. [Medline].

  27. Sevigny JJ, Albert SM, McDermott MP, Schifitto G, McArthur JC, Sacktor N, et al. An evaluation of neurocognitive status and markers of immune activation as predictors of time to death in advanced HIV infection. Arch Neurol. Jan 2007;64(1):97-102. [Medline].

  28. Chang L, Ernst T, Leonido-Yee M, Witt M, Speck O, Walot I, et al. Highly active antiretroviral therapy reverses brain metabolite abnormalities in mild HIV dementia. Neurology. Sep 11 1999;53(4):782-9. [Medline].

  29. Sacktor NC, Skolasky RL, Lyles RH, Esposito D, Selnes OA, McArthur JC. Improvement in HIV-associated motor slowing after antiretroviral therapy including protease inhibitors. J Neurovirol. Feb 2000;6(1):84-8. [Medline].

  30. Evers S, Grotemeyer KH, Reichelt D, Luttmann S, Husstedt IW. Impact of antiretroviral treatment on AIDS dementia: a longitudinal prospective event-related potential study. J Acquir Immune Defic Syndr Hum Retrovirol. Feb 1 1998;17(2):143-8. [Medline].

  31. Sacktor N, Skolasky RL, Tarwater PM, McArthur JC, Selnes OA, Becker J, et al. Response to systemic HIV viral load suppression correlates with psychomotor speed performance. Neurology. Aug 26 2003;61(4):567-9. [Medline].

  32. Brew BJ, Gonzalez-Scarano F. HIV-associated dementia: an inconvenient truth. Neurology. Jan 30 2007;68(5):324-5. [Medline].

  33. Evers S, Rahmann A, Schwaag S, Frese A, Reichelt D, Husstedt IW. Prevention of AIDS dementia by HAART does not depend on cerebrospinal fluid drug penetrance. AIDS Res Hum Retroviruses. May 2004;20(5):483-91. [Medline].

  34. Harrison MJ. Guidelines for management of HIV-associated dementia, myelopathy, neuropathy and myopathy. Int J STD AIDS. Jul 1998;9(7):390-3. [Medline].

  35. Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Clinical confirmation of the American Academy of Neurology algorithm for HIV-1-associated cognitive/motor disorder. The Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Neurology. Nov 1996;47(5):1247-53. [Medline].

  36. Bouwman FH, Skolasky RL, Hes D, Selnes OA, Glass JD, Nance-Sproson TE, et al. Variable progression of HIV-associated dementia. Neurology. Jun 1998;50(6):1814-20. [Medline].

  37. Sahai-Srivastava S. Medico-legal issues in HIV/AIDS in the 21st century. In: Goodkin EK, et al. The Spectrum of Neuro-AIDS Disorders: Pathophysiology, Diagnosis and Treatment. Washington, DC: ASM Press; 2008.

  38. Mancall EL, Munsat TL. The neurologic complications of AIDS. In: Continuum: Lifelong Learning in Neurology. Vol 6. Baltimore, Md: Lippincott Williams & Wilkins; 2000:30-64.

  39. Marder K, Albert SM, McDermott MP, McArthur JC, Schifitto G, Selnes OA, et al. Inter-rater reliability of a clinical staging of HIV-associated cognitive impairment. Neurology. May 13 2003;60(9):1467-73. [Medline].

  40. Simpson DM, Berger JR. Neurologic manifestations of HIV infection. Med Clin North Am. Nov 1996;80(6):1363-94. [Medline].

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Further Reading

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Keywords

AIDS dementia complex, ADC, subacute HIV encephalitis, AIDS-related dementia, HIV-related dementia, AIDS-induced dementia, HIV-induced dementia, viral dementia, virus-induced dementia, multinucleate giant cell encephalitis, HIV-1-associated cognitive/motor complex, AIDS encephalopathy, HIV dementia, HIV encephalopathy, dementia, mental illness, psychosis, subcortical dementia, depression

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Contributor Information and Disclosures

Author

Soma Sahai-Srivastava, MD, Director of Neurology Ambulatory Care Services, LAC and USC Medical Center; Assistant Professor, Department of Neurology, University of Southern California
Soma Sahai-Srivastava, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Arousiak Varpetian, MD, Assistant Professor of Clinical Neurology, Department of Neurology, University of Southern California Keck School of Medicine; Clinical Director, Rand Schrader Neurology Clinic (Los Angeles County-University of Southern California HIV Clinic)
Arousiak Varpetian, MD is a member of the following medical societies: American Academy of Neurology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

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

Managing Editor

Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories
Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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