AIDS Dementia Complex

AIDS dementia complex (ADC; also known as
HIV dementia, HIV encephalopathy and HIV-
associated dementia) is a common neurological
disorder associated with HIV infection and AIDS.
It is a metabolic encephalopathy induced by HIV
infection and fueled by immune activation of
brain macrophages and microglia.These cells are
actively infected with HIV and secrete neurotoxins
of both host and viral origin. The essential
features of ADC are disabling cognitive
impairment accompanied by motor dysfunction,
speech problems and behavioral change.
Cognitive impairment is characterised by mental
slowness, trouble with memory and poor
concentration. Motor symptoms include a loss of
fine motor control leading to clumsiness, poor
balance and tremors. Behavioral changes may
include apathy, lethargy and diminished
emotional responses and spontaneity.
Histopathologically, it is identified by the infiltration
of monocytes and macrophages into the central
nervous system (CNS), gliosis, pallor of myelin
sheaths, abnormalities of dendritic processes and
neuronal apoptosis.
ADC typically occurs after years of HIV infection
and is associated with low CD4+ T cell levels and
high plasma viral loads. It is sometimes seen as
the first sign of the onset of AIDS. Prevalence is
between 10-20% in Western countries and has
only been seen in 1-2% of India based infections.
This may have to do with differences in diets,
such as consumption of curcumin (in curry) and
EGCG or Theaflavins (in teas), both which can
pass the blood brain barrier and have
neuroprotective effects.With the advent of highly
active antiretroviral therapy (HAART), the
frequency of ADC has declined in developed
countries. HAART may not only prevent or delay
the onset of ADC in people with HIV infection, it
can also improve mental function in people who
already have ADC.
Dementia only exists when neurocognitive
impairment in the patient is severe enough to
interfere markedly with day-to-day function. That
is, the patient is typically unable to work and may
not be able to take care of him or herself. Before
this, the patient is said to have a mild
neurocognitive disorder.