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.

ℹ️ 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)

Stage 0 (Normal)	Normal mental and motor function.
Stage 0.5 (Subclinical)	Minimal symptoms or mild signs of cognitive or motor dysfunction without impairment in work or daily living activities (ADL). Gait and strength are normal.
Stage 1 (Mild)	Evidence of intellectual or motor impairment but able to perform most work and ADL tasks. Can walk unassisted.
Stage 2 (Moderate)	Unable to work or manage demanding daily tasks but capable of basic self-care. Ambulatory, but may require assistance or a prop for walking.
Stage 3 (Severe)	Severe intellectual and motor impairment; unable to follow news or personal events, engage in complex conversations, or walk unassisted without support.
Stage 4 (End Stage)	Vegetative state with minimal intellectual and social responses. Paraplegic, incontinent, and nearly mute.

💊 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.

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AIDS Dementia Complex (HIV)