AIDS Dementia Complex
(ADC; AIDS Encephalopathy; AIDS-related Dementia; ARD; HIV-associated Dementia Complex; HIV Encephalopathy; HIV Associated Encephalopathy (HAE), HIV associated Cognitive/Motor Complex)
Definition
AIDS dementia complex (ADC) can occur in people with AIDS. ADC results in changes in multiple neurologic areas:
- Cognition—the ability to understand, process, and remember information
- Behavior—difficulty performing daily tasks
- Emotions—may have personality changes and depression
- Motor coordination—the ability to coordinate muscles and movement
ADC is a common nervous system complication of late-stage HIV infection.
Immune System
HIV destroys white blood cells vital to the immune system.
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Risk Factors
Risk factors that increase your chances of having ADC include:
- Untreated HIV infection
- Late-stage AIDS
Symptoms
Symptoms usually develop slowly and worsen over time. They are grouped into stages:
Stage 1 (Mild)
- Difficulty concentrating
- Difficulty remembering details (eg, phone numbers, appointments, tracking daily activities)
- Slowed thinking
- Longer time needed to complete complicated tasks
- Irritability
- Unsteady walking, tremor, or difficulty keeping balance
- Poor hand function
- Change in handwriting
- Depression
Stage 2 (Moderate)
- Weakness
- More focus and attention needed
- Slow responses
- Frequently dropping objects
- Feelings of indifference or apathy
- Slowness or difficulty with normal activities (eg, eating, writing)
Walking, balance, and coordination require a great deal of effort at this stage.
Stages 3 and 4 (Severe and End Stage)
- Loss of bladder or bowel control
- Abnormal gait, making walking more difficult
- Muteness
- Withdrawing from life
- Severe mental disorder (ie, psychosis, mania)
- Unable to leave bed
If you have any of these symptoms, do not assume they are due to ADC. These symptoms may be caused by other conditions.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include:
- HIV test
- Mental status/neurological exam
- MRI scan or CT scan
- Spinal tap
- Electroencephalogram (EEG)
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include:
Antiretroviral Therapy
Anti-HIV drugs are often used to treat ADC. Your doctor will create a medicine plan that is right for you. These drugs are often given in combination.
Other Medications
Other medicines may be used along with antiretroviral therapy to treat symptoms of ADC. These may include:
- Antipsychotics
- Antidepressants
- Anti-anxiety medicines
- Stimulants
- Mood stabilizers
- Medicines to prevent seizures
Prevention
ADC occurs in people with HIV. Ways to help reduce the risk of getting HIV include:
- Abstain from sex.
- If you do have sex, use a male latex condom.
- Limit your number of sexual partners.
- Avoid sexual partners who are HIV-infected or injection drug users.
- Do not share needles for drug injection.
- Avoid having transfusions of blood products that have not been screened.
-
If you are a healthcare worker:
- Wear appropriate gloves and facial masks during all procedures.
- Carefully handle and properly dispose of needles.
- Carefully follow universal precautions.
-
If you live in a household with someone who has HIV:
- Wear appropriate gloves if handling HIV-infected bodily fluids.
- Cover your cuts and sores with bandages. Also cover cuts and sores on the person with HIV.
- Do not share any personal hygiene items (eg, razors, toothbrushes).
- Carefully handle and properly dispose of needles used for medicine.
RESOURCES:
American Foundation for AIDS Research
http://www.amfar.org/
National Association of People with AIDS
http://www.napwa.org/
CANADIAN RESOURCES:
AIDS Committee of Toronto
http://www.actoronto.org/
Canadian AIDS Society
http://www.cdnaids.ca/
REFERENCES:
AIDS dementia complex. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointofcare . Updated February 28, 2012. Accessed November 21, 2012.
AIDS dementia complex. Project Inform website. Available at: http://www.projectinform.org/publications/adc/ . Updated January 2011. Accessed November 21, 2012.
AIDS dementia complex. University of California at San Francisco website. Available at: http://hivinsite.ucsf.edu/InSite?page=id-01-08 . Accessed November 21, 2012.
HIV-associated dementia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated February 10, 2012. Accessed November 21, 2012.
Luo X, Carlson KA, Wojna V, et al. Macrophage proteomic fingerprinting predicts HIV-1-associated cognitive impairment. Neurology. 2003;60:1931-1937.
Meehan RA, Brush JA. An overview of AIDS dementia complex. Am J Alzheimers Dis Other Demen. 2001;16:225-229.
Nicholas MK, Lukas R, van Besein K. Textbook of Neurological Surgery. 6th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2011: chap 46.
Royal W. HIV-associated Dementia. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corp.
Last reviewed November 2012 by Rimas Lukas, MD
Last Updated: 11/26/2012