HIV-associated dementia is progressive deterioration in mental function due to infection with human immunodeficiency virus (HIV).
In the late stages of HIV infection (see see Human Immunodeficiency Virus (HIV) Infection), the virus may directly infect the brain. HIV damages nerve cells, causing dementia. Dementia may also result from other infections that people with HIV infection are prone to get. Unlike almost all other forms of dementia, it tends to occur in younger people.
This dementia usually begins subtly but progresses steadily over a few months or years. It usually develops after other symptoms of HIV infection. Symptoms of this dementia include slowed thinking and expression, difficulty concentrating, and apathy, but insight is not affected. Movements are slow, muscles are weak, and coordination may be impaired.
In some people, a psychosis, such as hallucinations, delusions, or paranoia, develops. Some people become manic. That is, they become very restless and overactive. They may speak rapidly and act without good judgment.
Generally, diagnosis is similar to that of other dementias (see Diagnosis).
When HIV infection is diagnosed or when mental function changes in people with HIV infection, computed tomography (CT) or magnetic resonance imaging (MRI) is done to check for other brain infections, such as toxoplasmosis (a parasite infection). When the change occurs suddenly, the cause must be identified quickly because early treatment can prolong life. Untreated, HIV-associated dementia may cause death within 6 months.
Unless results of CT or MRI suggest that pressure within the skull is increased, doctors usually do a spinal tap (lumbar puncture) to obtain a sample of cerebrospinal fluid, which is analyzed and checked for infection. Findings can support but not confirm the diagnosis of HIV-associated dementia.
HIV-associated dementia usually progresses, eventually becoming severe. Without treatment, it can be fatal. However, when HIV infection is treated with combined antiretroviral therapy (CART), mental function sometimes dramatically improves. CART consists of combinations of the drugs used to treat HIV infection (see Antiretroviral Drugs). However, because the infection is not cured, dementia may recur.
Treatment also includes general measures to provide support, as for all dementias (see Treatment).
Last full review/revision July 2013 by Juebin Huang, MD, PhD