HIV-associated dementia: symptoms, diagnosis and treatment

HIV-associated dementia is a progressive deterioration of a person's mental function due to infection of the brain by the human immunodeficiency virus (HIV).

Dementia due to HIV

HIV-associated dementia is characterized by the following features:

• unlike other forms of dementia, HIV-associated dementia can develop in young people;
• Often, dementia begins unnoticed but progresses steadily over several months or years, usually after the development of other symptoms of HIV infection;
• Doctors diagnose HIV-related dementia based on symptoms, a mental status test, blood tests for HIV infection, and imaging tests;
• Treatment of HIV infection with antiretroviral therapy sometimes significantly improves mental functioning but does not completely cure dementia.

In the later stages of HIV infection, the virus can infect the brain, thereby damaging nerve cells and causing dementia.

Dementia is a chronic, usually irreversible, decline in cognitive function that affects all aspects of cognitive activity. HIV-associated dementia (AIDS dementia) can develop in the later stages of HIV infection. Unlike other types of dementia, it occurs mainly in young people.

In people with HIV infection, dementia can also occur as a result of other disorders (such as lymphoma that affects the brain) and infections that occur when the immune system is weakened. These infections are called opportunistic infections and include progressive multifocal leukoencephalopathy, toxoplasmosis (a parasitic infection), fungal meningitis, and others.

Symptoms of HIV dementia

HIV-associated dementia usually begins unnoticed but progresses steadily over months or years. Usually develops after other symptoms of HIV infection.

Early symptoms of HIV-associated dementia include:

• slow thinking and expression;
• difficulty concentrating;
• apathy.

Movements are slow, muscles are weak, coordination may be impaired.

Some people develop psychosis, including hallucinations, delusions, or paranoia. Some people become very restless and overactive. Without treatment, HIV-associated dementia tends to progress and become more severe.

Diagnosis of HIV-associated dementia

To diagnose HIV-associated dementia, doctors typically do magnetic resonance imaging (MRI) to check for other brain infections, such as toxoplasmosis. When the change occurs suddenly, the cause must be identified quickly because early treatment can prolong life. Without treatment, HIV-associated dementia can lead to death within 6 months.

If the results of a computed tomography (CT) scan or MRI do not reveal increased intracranial pressure, doctors usually do a spinal tap (lumbar puncture) to obtain a sample of cerebrospinal fluid, which is analyzed and checked for infection. The results help confirm or rule out a diagnosis of HIV-associated dementia.

If people with HIV infection suspect human immunodeficiency virus-related dementia, doctors do blood tests to measure the following:

• the number of white blood cells called CD4 lymphocytes;
• HIV viral load.

These tests help determine how serious the HIV infection is. If a person has HIV infection and dementia, tests can help determine whether HIV infection is contributing to the development of dementia.

Treatment and prognosis

The primary treatment for HIV-related dementia is antiretroviral therapy to increase CD4 cell counts and improve cognitive function.

Without treatment, HIV-associated dementia can be fatal. However, when HIV infection is treated with antiretroviral therapy (ART) , mental function sometimes improves significantly. ART consists of a combination of drugs used to treat HIV infection. However, because HIV infection is not completely cured, dementia may recur.

Treatment also includes general measures of support and care, as creating a safe and supportive environment for people with HIV-associated dementia is very important.

For example, the environment should be bright, fun and familiar, and should be aimed at reinforcing orientation (eg, placing large clocks and calendars in the room). Patient safety measures (eg alarm monitoring systems for patients who may become lost) should be implemented.

As a person with HIV-associated dementia worsens, treatment tends to focus on maintaining comfort rather than prolonging their life.