Opened database successfully add two inverted commas for every one Medicine for Medical Students, Doctors, Physicians, Surgeons, Allied Healthcare Professionals

MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd

AIDS Dementia Complex (HIV)

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

Twitter

Urology

Version Jan 2023

Early disease can cause a lack of sexual inhibition and more risky behaviour in terms of unprotected sex

About

It is rare when anti-retroviral therapy is used

Aetiology

Possibly enters the brain via HIV-infected macrophages and lymphocytes.
When CD4+ lymphocyte counts fall below 200 cells/mL
HIV infection of glial and neuronal cells
Pathology shows basal ganglia, subcortical regions, and frontal cortex damage

Clinical

Gradual onset with progressive cognitive impairment
Change in personality and psychomotor slowing
Depression and psychosis

Differentials

CNS lymphoma, Vascular dementia
CJD in a young patient

Investigations

FBC: WCC may be reduced. HIV test, CD count and viral load
U&E, LFT, TFT, B12, folate. Glucose
CT in advanced disease may show areas of hypoattenuation
MRI: shows white matter disease usually all subcortical
EEG : encephalopathic features
Lumbar puncture for CSF
- Raised CSF beta-2 microglobulin
- Elevated protein (60%)
- Elevated immunoglobulin G (80%)
- Oligoclonal bands are sometimes present.
- Cells: Usually acellular, but a mononuclear pleocytosis is found in 25%.
- HIV antibodies are present

Staging

Stage 0 (Normal)	Normal Mental and Motor Function
Stage 0.5 (Subclinical)	Minimal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs, slowed extremity movements), but without impairment of work or capacity to perform activities of daily living (ADL). Gait and strength are normal.
Stage 1 (Mild)	Evidence of functional intellectual or motor impairment characteristic of ADC, but able to perform all but the more demanding aspects of work or ADL. Can walk without assistance.
Stage 2 (Moderate)	Cannot work or maintain the more demanding aspects of daily life, but able to perform basic activities of self care. Ambulatory, but may require a single prop.
Stage 3 (Severe)	Major intellectual incapacity - cannot follow news or personal events, cannot sustain complex conversation, considerable slowing of all output. And/or motor disability - cannot walk unassisted, requiring a walker or personal support, usually with slowing and clumsiness of arms as well.
Stage 4 (End Stage)	Nearly vegetative. Intellectual and social comprehension and responses are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with urinary incontinence and faecal incontinence.

Management

Referral to HIV specialists and initiation of HAART can be helpful

References

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Hits