Aids Dementia Complex (ADC)
by Jos van der Poel
Through the majority of patients with HIV do not develop dementia (due to treatment with AZT and combination therapy), the AIDS Dementia Complex may occur when a HIV-infection affects neurons in the brain. The disease mainly occurs in later stages of the infection, and appears to involve subcortical, rather than cortical, brain structures. There is more dysfunction than destruction of neurons. Characteristic are memory problems, slow and unsteady movements, anxiety and mood-swings.
HIV/AIDS encephalopathy, HIV/AIDS related brain impairment, HIV dementia.
Symptoms and course
Symptoms, which may vary from person to person, are:
- concentration problems
- language difficulties
- slowing down of thinking
- slow, unsteady movements
- difficulty keeping balance
- coordination problems
- jerky eye movements
- personality changes, mood-swings
- sleep disturbances
- loss of appetite
The number of symptoms gradually increases. Sometimes psychosis, depression and suicide occur.
ADC may begin at a relatively young age. At first symptoms resemble those of depression. Psychiatric symptoms.
Causes and risk factors
The precise role of HIV in ADC is unknown. Probably the virus is included by macrophages, which take the virus to the brain where it infects microglia.
It is difficult to be precise about the incidence of Aids-related cognitive impairment. Estimates are from 5 – 15 % of all AIDS patients. Many of the studies into its incidence were carried out before the introduction of 'combination therapy.
- HIV test to demonstrate the viral infection
- CT and MRI scan to demonstrate the absence of opportunistic infections and tumors
- lumbar puncture to demonstrate HIV-1 p24 antigene
- neuropsychometric testing to demonstrate subcortical dementia
Care and treatment
At the moment it is not possible to cure AIDS. Anti-HIV drugs however decrease the amount of the virus in the bloodstream, reducing the damage it can cause. The success of these drugs has meant that the focus of treatment has now shifted from palliative care to rehabilitation: relearn the skills the patient need to care for himself (like dressing, taking medication, cooking etc.).
Ongoing research/Clinical trials
Development of therapeutic strategies to prevent neurological complications in AIDS and the role of macrophages in neurological diseases.
The International HIV/AIDS Alliance Queensberry House 104–106 Queens Road Brighton BN1 3XF United Kingdom Telephone: +44 1273 718 900 Fax: +44 1273 718 901 firstname.lastname@example.org www.aidsalliance.org
AIDS associations provide information on HIV, but have less information on the cognitive problems associated with the disorder.
Alzheimer Europe 145 Route de Thionville L- 2611 Luxembourg Tel: +352 / 29.79.70 Fax: +352 / 29.79.72 email@example.com www.alzheimer-europe.org
Alzheimer's Disease International 45-46 Lower Marsh London SE1 7RG United Kingdom Tel: +44 / 20 7620 3011 Fax: +44 / 20 7401 7351 firstname.lastname@example.org www.alz.co.uk
- Kaul M, Garden G, Lipton S; Pathways to neuronal injury and apoptosis in HIV-associated dementiaNature, vol. 410, 19 April 2001, p. 988-994
- Berghuis J, Uldall K, Lalonde B; Validity of two scales in identifying HIV-associated dementiaJournal of AIDS, 21, 1999, p. 134-140
- Portegies P; Characterisation of AIDS Dementia Complex, diagnosis and preventionDissertation, University of Amsterdam, 1993
- Key S; Hypothesis Presented on how AIDS-related dementia develops
- AIDS weekly plus magazine, December 14, 1998
- Henderson C; Researchers to determine if anti-inflammatories are useful for AIDS Dementia, Alzheimer’sAIDS Weekly Magazine, October 16 & 23, 2000
Last Updated: vendredi 09 octobre 2009