Pediatric HIV Infection: Practice Essentials, Background, Pathophysiology
Dementia Caused By HIV/AIDS: Scale, Symptoms, Treatments - WebMD
Decline in mental processes is a complication of advanced HIV infection.
AIDS dementia complex typically occurs as the CD4+ count falls to less than 200 cells/microliter. It may be the first sign of AIDS. With the advent of antiretroviral therapy (ART), the frequency of ADC has declined. ART may not only prevent or delay the onset of AIDS dementia complex in people with HIV infection, it can also improve mental function in people who already have ADC.
AIDS dementia complex is caused by the HIV virus itself, not by the opportunistic infections that commonly occur in advanced HIV. We do not know exactly how the virus damages brain cells.
HIV may affect the brain through several mechanisms. Viral proteins may damage nerve cells directly or by infecting inflammatory cells in the brain and spinal cord. HIV may then induce these cells to damage and disable nerve cells. HIV causes generalized inflammation, which can cause memory issues, as well as other aging processes, including heart disease.
AIDS dementia complex can affect behavior, memory, thinking, and movement. At first, symptoms are subtle and may be overlooked, but they gradually become troublesome. The symptoms vary widely from person to person.
Symptoms of early dementia include:
Initially, a subtle disease can progress to more severe symptoms such as:
Without ART, these symptoms gradually worsen. They can lead to a vegetative state, in which the person has minimal awareness of his or her surroundings and is incapable of interacting.
In a person who's known to have an HIV infection, cognitive, behavioral, or motor symptoms suggest that the person might have ADC. It's important to consider, however, other possible causes of these symptoms, such as metabolic disorders, infections, degenerative brain diseases, stroke, tumor, and many others. Your healthcare provider will carry out an evaluation to determine the cause of your symptoms. This will likely include a medical interview, physical and mental status exams, CT or MRI scans, neuropsychological testing, and, possibly, a spinal tap.
Imaging Studies
CT scan and MRI may detect changes in the brain that support the diagnosis of AIDS dementia complex. Brain changes in ADC worsen over time, so these studies may be repeated periodically. Importantly, these scans help rule out other potentially treatable conditions such as infection, stroke, and brain tumor.
A CT scan or an MRI gives a detailed, 3-dimensional picture of the brain. These scans can show brain atrophy (shrinkage) that is consistent with ADC, as well as changes in the appearance of different parts of the brain.
Lab Tests
No lab test confirms the diagnosis of AIDS dementia complex. If you have lab tests, they serve to rule out conditions that might cause similar symptoms. You may have blood drawn for multiple tests.
Your healthcare provider may test your cerebrospinal fluid (CSF). This clear fluid is made in normal cavities in the brain called ventricles, which are seen on a CT scan or an MRI. The fluid surrounds the brain and spinal cord. It cushions and protects these structures and may distribute both beneficial and harmful substances. CSF can be tested for various abnormalities that are related to dementia symptoms. A sample of the CSF is obtained with a lumbar puncture, also called a spinal tap. This procedure involves the removal of a sample of CSF from the spinal canal in the lower back.
Electroencephalography
For electroencephalography (EEG), a series of electrodes are attached to the scalp. The electrical activity of the brain is read and recorded. In the later stages of ADC, the electrical activity (which appears as waves) is slower than normal. EEG also is used to see whether a person is having seizures.
Neuropsychological Testing
Neuropsychological testing is the most accurate method of pinpointing and documenting your cognitive abilities. This can help give a more accurate picture of the problems and thus can help in treatment planning. It might be repeated later to monitor changes in symptoms.
The testing involves answering questions and performing tasks that have been carefully prepared for this purpose. The test is given by a neurologist, psychologist, or other specially trained professional. It addresses your ability to think mood, anxiety level, and experience of delusions or hallucinations.
Testing assesses cognitive abilities such as:
Reasoning, abstract thinking, and problem solving are also tested.
Just as there is no cure for AIDS, there is no cure for AIDS dementia complex. However, ADC can be controlled in some people by other appropriate treatments; the most important treatment is effective ART.
If you have AIDS dementia complex, you should remain physically, mentally, and socially active as long as you are able.
A balanced and nutritious diet that includes plenty of fruits and vegetables helps maintain a healthy weight and prevent malnutrition and constipation. You should not smoke both for health and safety reasons.
Combination antiretroviral therapy (ART), which is effective in controlling HIV infection, also protects many HIV-positive people from developing AIDS dementia complex. In cases of advanced HIV in which ADC is present, ART can partially or completely reduce symptoms of ADC.
No specific treatment is available for cognitive decline in AIDS. Specific symptoms such as depression and behavioral disturbances are sometimes relieved by drug therapy.
These "psychoactive" drugs are not appropriate for everyone. Your health care provider may consult a specialist in brain disorders (neurologist or psychiatrist) to determine the best treatment.
If you have AIDS dementia complex, you should have regular and frequent visits with your health care provider. These visits allow repeat testing to monitor your condition, review of symptoms, and adjustments to treatment if needed. The visits also permit the health care provider to assess whether your care is appropriate.
Persons with advanced dementia may require inpatient care in a nursing home or similar facility.
Combination antiretroviral therapy (ART) can delay or prevent the development of AIDS dementia complex in people with HIV infection, especially if it is given early in the course of the disease. There is no other known way of preventing ADC.
In people who already have advanced HIV and ADC, combination ART will likely result in some improvement in symptoms. If there is no response to ART, the outlook may be poor. For some, the dementia worsens over a period of months until the person is no longer able to care for himself. He or she becomes bedridden, unable to communicate, and dependent on others for care.
AIDS dementia complex can be one of the most difficult of all HIV/AIDS complications for you and those who care for you. The condition affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel overwhelmed, depressed, frustrated, angry, or resentful.
While understandable, these feelings do not help the situation and usually make it worse. This is why support groups were invented. Support groups are groups of people who have lived through the same difficult experiences and want to help themselves and others by sharing coping strategies.
Support groups meet in person, on the telephone, or on the Internet. The following organizations may help you find a support group that is right for you. You can also ask your health care provider or behavior therapist, or go on the Internet. If you do not have access to the Internet, go to the public library.
Centers for Disease Control and Prevention, National Prevention Information Network(800) HIV-0440 (800-448-0440)(888) 480-3739 TTY1-301-519-0459 InternationalEmail: [email protected]Web Site: npin.Cdc.Gov
Family Caregiver Alliance/National Center on Caregiving(800) 445-8106Email: [email protected]Web Site: www.Caregiver.Org
National Alliance for Caregiving(301) 718-8444Email: [email protected]Web Site: www.Caregiving.Org
Media file 1: CT scan of the brain of a patient with AIDS dementia complex (ADC) shows diffuse atrophy (loss of tissue) and ventricular enlargement and attenuation (dark areas) around the ventricles in the white matter.
Media type: CT
Media file 2: T2-weighted MRI shows ventricular enlargement and large areas of hyperintense signal in the subcortical white matter of both frontal lobes.
Media type: MRI
Media file 3: Photomicrograph from a patient with AIDS dementia complex (ADC) shows perivascular and parenchymal infiltrates of lymphocytes and macrophages. These often form microglial nodules. Contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis.
Media type: Photo
Media file 4: Photomicrograph from patient with AIDS dementia complex (ADC) illustrates the intense astrogliosis (scarring) that is characteristic of HIV encephalitis. Contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis.
Media type: Photo
Media file 5: Multinucleated giant cells, as shown here, are a hallmark of HIV encephalitis and harbor the virus. Contributed by Dr. Beth Levy, Saint Louis University Health Sciences Center, St. Louis.
Media type: Photo
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A Timeline Of HIV Symptoms: How Does It Progress?
HIV is a virus that compromises the immune system. There is currently no cure for HIV, but since the late 1980s, treatment in the form of antiretroviral drugs has been available to help reduce the impact of any symptoms.
In the majority of cases, once a person contracts HIV, the virus stays in the body for life. However, HIV symptoms are unlike the symptoms of other viral infections in that they come in stages.
If left untreated, the disease caused by the infection has three phases. Each has different potential symptoms and complications.
But regular antiretroviral treatment can reduce HIV to undetectable levels in the blood. This means the virus won't progress to the later stages of HIV infection or be transmitted to a partner during sex.
The first noticeable stage is primary HIV infection. This stage is also called acute retroviral syndrome (ARS), or acute HIV infection.
It usually causes flu-like symptoms, so it's possible for someone in this stage to think they have severe flu or another viral illness rather than HIV. Fever is the most common symptom.
ARS is common once a person develops HIV. But this isn't the case for everyone as, according to HIV.Gov, symptoms may not appear for a decade or longer.
Although the virus replicates quickly in the weeks after contracting it, symptoms in early HIV only tend to show up if the rate of cell destruction is high.
This doesn't mean that cases of HIV without symptoms are less serious or that an asymptomatic person can't transmit the virus to others.
Share on PinterestHIV has multiple stages of infection. In the early stage after an exposure, symptoms may include flu or cold symptoms. This can resolve spontaneously while HIV is still active in the body. It will then progress to a chronic infection, where the symptoms can vary greatly but include weight loss, fatigue, and unexplained fevers. The chronic stage can happen at any time after the acute stage, but it may not be immediately after. If untreated, HIV can progress to AIDS, which is diagnosed based on the number of a white blood cell type that is circulating in the blood.After initial exposure and possible primary infection, HIV may transition to the clinically latent infection stage. Due to a lack of symptoms in some people, this is also referred to as asymptomatic HIV infection.
According to HIV.Gov, latency in HIV infection can last up to 10 or 15 years. This means that the virus is replicating much slower than before. But it doesn't mean that HIV is gone, nor does it mean that the virus can't be transmitted to others.
Although many people are asymptomatic during this stage, some may still have symptoms after the acute infection.
Symptoms of chronic HIV can vary, ranging from minimal to more severe. People may experience episodes of the following, particularly in advanced stages:
Clinically latent infection may progress to the third and final stage of HIV, known as AIDS. The chance of progression is higher if a person with HIV isn't receiving or adhering to treatment, such as antiretroviral therapy.
CD4 levels below 200 cells per cubic millimeter (mm3) of blood is one indication that HIV has progressed to its final stage. A normal range is 500 to 1,600 cells/mm3.
Sometimes, AIDS is determined simply by a person's overall health — it develops when HIV has significantly weakened the immune system and can lead to AIDS-defining conditions, such as certain infections and cancers, that are rare in people who don't have HIV.
Symptoms of AIDS include:
The CDC recommends that anyone between the ages of 13 and 64 get tested at least once for HIV.
Individuals who might contract HIV more frequently are advised to test at least once every year. This may include people:
You can find a local testing site here.
There are a few different types of tests, and each has a different window period— the time between potential exposure to HIV and when a test will be able to detect the virus. If you could have been exposed to HIV in the past 72 hours, taking postexposure prophylaxis (PEP) can help prevent transmission.
Nucleic acid tests are usually able to detect an HIV infection between 10 and 33 days after exposure.
Antigen/antibody tests using blood from a vein have a typical window period of 18 to 45 days, while finger prick antigen/antibody tests can be used 23 to 90 days after potential exposure.
A negative result should be double-checked with a second test after the window period.
A positive result will also be checked with a follow-up test (aka "confirmatory testing"). If the second test comes back positive, you will be diagnosed with HIV.
Finding out that you're HIV-positive can be difficult for some. But there are healthcare professionals out there who can help — both physically and emotionally.
Your usual clinician may be able to help directly or refer you to a one experienced with HIV. Alternatively, you can find a local clinician experienced with HIV here.
It's important to start treatment as soon as HIV is diagnosed. Consult a doctor or other healthcare professional if you experience any new or worsening symptoms.
The infection can be managed with antiretroviral drugs. These will need to be taken during all stages of HIV — even if there aren't any noticeable symptoms.
They reduce the amount of virus inside the body by stopping it from replicating, and can lower levels so significantly that the virus becomes undetectable.
Medications therefore help to prevent progression of the disease, maintain quality of life, and can stop the virus from being transmitted to others via sex.
You may be given a combination of drugs to stop the virus from becoming resistant. The majority of people have an undetectable viral load within 6 months.
If this isn't achievable, any sexual partners can be protected by taking a medicine called preexposure prophylaxis (PrEP). Condoms should also be used to help prevent transmission during sex.
Your clinician will continue to monitor the amount of HIV in your blood with viral load tests and check the number of CD4 cells in your blood — these help combat infections.
If HIV progresses to AIDS, other medical interventions are usually necessary to treat AIDS-related illnesses or complications that can be fatal.
Without treatment, the CDC estimates the average survival rate to be 3 years once AIDS is diagnosed.
HIV has three stages — each with its own set of symptoms.
The first symptoms often appear within a few weeks of exposure. However, some people experience no symptoms until years later.
Regular testing is crucial if you have a higher chance of contracting HIV. With swift and proper treatment, the infection and its symptoms can be managed, helping you and any sexual partners to stay as healthy as possible.
Lauren Sharkey is a U.K.-based journalist and author specializing in women's issues. When she isn't trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.
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Jane Yoon Scott, MD, is an infectious disease physician and an assistant professor of medicine at Emory University in Atlanta. Dr. Scott enjoys connecting with her patients, empowering them to understand and take ownership of their health, and encouraging them to ask questions so that they can make informed and thoughtful decisions.
She graduated with the highest honors from the Georgia Institute of Technology, then received her MD from the Medical College of Georgia. She completed her internal medicine residency training and chief residency at Temple University Hospital, as well as a fellowship in infectious diseases at Emory University. She is board-certified in both internal medicine and infectious diseases.
When she is not seeing patients, Dr. Scott works with neighboring health departments to promote public health, especially to communities that have been historically underserved. She also teaches medical trainees and lectures medical students at the Emory University School of Medicine.
In her free time, Dr. Scott appreciates a good coffee shop, weekend hikes, playing guitar, strolling through cities, sampling restaurants, and traveling to new places.
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