HIV associated dementia
HIV associated dementia (HAD), previously referred to as AIDS dementia complex (ADC), corresponds to a neurological clinical syndrome seen in patients with HIV infection. The associated imaging appearance is generally referred to as HIV encephalopathy.
The terms HIV dementia complex, AIDS dementia complex (ADC), HIV-associated dementia (HAD) and HIV encephalopathy (HIE) are being replaced by more clear definitions for the spectrum HIV associated neurocognitive disorder (HANDs). The progressive impairment described as ADC is now referred to as HIV associated dementia (HAD) using the most recent criteria 4,5.
The clinical syndrome of HAD comprises of a combination of cognitive, behavioural and motor dysfunction like gait disturbance and tremors . While there is some individual variation, frequent manifestations include: inattention and reduced concentration, apathy and dulling of personality, psychomotor slowing, marked motor slowing and ataxia.
Imaging findings include:
- diffuse and symmetric cerebral atrophy, out of proportion in keeping with age of patient
- symmetric periventricular and deep white matter hypoattenuation
- symmetric periventricular and deep white matter T2 hyperintensity with relative sparing of the subcortical white matter and posterior fossa structures
- confluent or patchy
- no mass effect
- no enhancement
May show decreased N acetyl aspartate and increased choline peaks and changes in the glutamate and glutamine levels.
Treatment and prognosis
Severity is related to the patient's viral load, and can regress with highly active antiretroviral therapy (HAART). Superimposed infection may lead to fulminant disease. Overall prognosis is not good, generally leading to death in less than a year 5.
History and etymology
The term AIDS dementia complex was introduced by Bradford Navia, an American physician, and colleagues in 1986 4. It was replaced by HIV-associated dementia after the publication of Antinori et al in 2007 5,6.
- 1. MBA DMYMD, Zimmerman RD, Grossman RI. Neuroradiology. Mosby. (2010) ISBN:0323045219. Read it at Google Books - Find it at Amazon
- 2. Smith A, Smirniotopoulos J, Rushing E. Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation1. Radiographics. 2008;28 (7): 2033-2058. Radiographics (full text) - doi:10.1148/rg.287085135
- 3. M.D. JC, M.D. BJ, Cockerell CJ. HIV/AIDS in the Post-HAART Era, Manifestations, Treatment, and Epidemiology. Pmph-usa. (2011) ISBN:1607951053. Read it at Google Books - Find it at Amazon
- 4. Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I. Clinical features. Ann. Neurol. 1986;19 (6): 517-24. doi:10.1002/ana.410190602 - Pubmed citation
- 5. Antinori A, Arendt G, Becker JT et-al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69 (18): 1789-99. doi:10.1212/01.WNL.0000287431.88658.8b - Free text at pubmed - Pubmed citation
- 6. Clifford DB, Ances BM. HIV-associated neurocognitive disorder. Lancet Infect Dis. 2013;13 (11): 976-86. doi:10.1016/S1473-3099(13)70269-X - Free text at pubmed - Pubmed citation
- manifestations of HIV/AIDS
- CNS manifestations
- pulmonary manifestations
- cardiovascular manifestations
- gastrointestinal manifestations
- hepatobiliary manifestations
- genitourinary manifestations
- musculoskeletal manifestations
- AIDS defining illnesses
- HIV associated neoplasms
- immune reconstitution inflammatory syndrome (IRIS)
- AIDS embryopathy