HIV encephalopathy

A decline in cognitive function is common in advanced HIV infection, although with more subtle neuropsychological and neurophysiological techniques, it is possible to demonstrate mild mentation defects in early infection.52 Pathological changes found at autopsy include brain atrophy, most prominent in the hippocampus and basal ganglia, with sulcal widening and ventricular dilatation. The usual course is for subjects to become inattentive, clumsy, and to have short term memory loss. In time, the subject becomes withdrawn, apathetic, and mentally slow, with akinetic dementia.42 The course may, however, be interrupted by acute relapses with confusion and psychosis, when the patient may present as a neurological emergency, when it is necessary to exclude other CNS infections, neoplasia, and systemic illness as a cause.

In HIV encephalopathy, CT is normal or shows cerebral atrophy and MRI demonstrates diffuse white matter abnormalities, which correlate with neuropathological changes. CSF examination is likely to be abnormal as described and it is necessary to exclude complicating infection. In HIV-infected children, 50% develop a similar progressive encephalopathy that is usually fatal within a year.

A decline in the incidence of HIV dementia has been noted following the introduction of highly active antiretroviral therapies (HAART) and there is anecdotal evidence that such treatment improves abnormal brain metabolism associated with HIV dementia.

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