Neurology, Vol 50, Issue 6 1814-1820, Copyright © 1998 by American Academy of Neurology

ARTICLES

Variable progression of HIV-associated dementia

FH Bouwman, RL Skolasky, D Hes, OA Selnes, JD Glass, TE Nance-Sproson, W Royal, GJ Dal Pan and JC McArthur
Johns Hopkins University, Department of Neurology, Baltimore, MD, USA.

A consecutive series of 71 patients diagnosed with HIV-associated dementia (HAD) (1984-1994) were studied to characterize the clinical course of HAD, and to identify predictive markers of rapid neurologic progression. Neurologic progression rate was determined from the change in the Memorial Sloan Kettering (MSK) dementia severity score from diagnosis to death. Those with the most rapid progression in neurologic disability were compared with those with slow or no progression. Autopsy material was immunostained for macrophage activation markers and gp41 in 30 individuals. Median survival was 3.3 months and 6.1 months for rapid-progression and no-progression patients, respectively. Rapid progression was associated with injection drug use but not with race, gender, or age. CD4+ cell counts were lower at diagnosis among rapid-progression than no-progression patients but no differences in AIDS-defining illnesses or patterns of antiretroviral therapy were found. At presentation, rapid-progression patients had more prominent symptoms of mental slowing than those with no progression; however, no other clinical features, CSF, or imaging features distinguished the groups. Less abundant macrophage activation in both basal ganglia and midfrontal gyrus regions, as judged by HAM56 immunostaining, was noted in 9 no-progression patients, compared with 12 rapid-progression patients. Neurologic progression and survival with HAD is highly variable. A significant proportion of individuals with dementia have prolonged survival of more than 12 months and remain cognitively stable. A history of injection drug use and presentation with prominent psychomotor slowing is associated with more rapid neurologic progression, and these patients tend to show more abundant macrophage activation within the CNS.

This article has been cited by other articles:

				S. Venneti, D. Bonneh-Barkay, B. J. Lopresti, S. J. Bissel, G. Wang, C. A. Mathis, M. Piatak Jr., J. D. Lifson, J. O. Nyaundi, M. Murphey-Corb, et al. Longitudinal in Vivo Positron Emission Tomography Imaging of Infected and Activated Brain Macrophages in a Macaque Model of Human Immunodeficiency Virus Encephalitis Correlates with Central and Peripheral Markers of Encephalitis and Areas of Synaptic Degeneration Am. J. Pathol., June 1, 2008; 172(6): 1603 - 1616. [Abstract] [Full Text] [PDF]

				Y. Wu, P. Storey, B.A. Cohen, L.G. Epstein, R.R. Edelman, and A.B. Ragin Diffusion Alterations in Corpus Callosum of Patients with HIV AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 656 - 660. [Abstract] [Full Text] [PDF]

				K Rostasy, L Monti, S A Lipton, J C Hedreen, R G Gonzalez, and B A Navia HIV leucoencephalopathy and TNF{alpha} expression in neurones J. Neurol. Neurosurg. Psychiatry, July 1, 2005; 76(7): 960 - 964. [Abstract] [Full Text] [PDF]

				A. B. Ragin, P. Storey, B. A. Cohen, R. R. Edelman, and L. G. Epstein Disease burden in HIV-associated cognitive impairment: A study of whole-brain imaging measures Neurology, December 28, 2004; 63(12): 2293 - 2297. [Abstract] [Full Text] [PDF]

				J. C. McArthur, M. P. McDermott, D. McClernon, C. St Hillaire, K. Conant, K. Marder, G. Schifitto, O. A. Selnes, N. Sacktor, Y. Stern, et al. Attenuated Central Nervous System Infection in Advanced HIV/AIDS With Combination Antiretroviral Therapy Arch Neurol, November 1, 2004; 61(11): 1687 - 1696. [Abstract] [Full Text] [PDF]

				G. Gekker, S. Hu, M. P. Wentland, J. M. Bidlack, J. R. Lokensgard, and P. K. Peterson {kappa}-Opioid Receptor Ligands Inhibit Cocaine-Induced HIV-1 Expression in Microglial Cells J. Pharmacol. Exp. Ther., May 1, 2004; 309(2): 600 - 606. [Abstract] [Full Text] [PDF]

				D. De Ronchi, I. Faranca, D. Berardi, P. Scudellari, M. Borderi, R. Manfredi, and L. Fratiglioni Risk Factors for Cognitive Impairment in HIV-1-Infected Persons With Different Risk Behaviors Arch Neurol, May 1, 2002; 59(5): 812 - 818. [Abstract] [Full Text] [PDF]

				S. H. Patel, D. L. Kolson, G. Glosser, I. Matozzo, Y. Ge, J. S. Babb, L. J. Mannon, and R. I. Grossman Correlation between Percentage of Brain Parenchymal Volume and Neurocognitive Performance in HIV-Infected Patients AJNR Am. J. Neuroradiol., April 1, 2002; 23(4): 543 - 549. [Abstract] [Full Text] [PDF]

				E. A. Childs, R. H. Lyles, O. A. Selnes, B. Chen, E. N. Miller, B. A. Cohen, J. T. Becker, J. Mellors, and J. C. McArthur Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy Neurology, February 1, 1999; 52(3): 607 - 607. [Abstract] [Full Text] [PDF]