Changes to AIDS dementia complex in the era of highly active antiretroviral therapy

Dore, Gregory J.; Correll, Patricia; Li, Yueming; Kaldor, John; Cooper, David A.; Brew, Bruce J.

doi:10.1097/00002030-199907090-00015

Cited by 405 publications

(216 citation statements)

References 23 publications

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“…The magnitude of this increase, along with the demonstrated increase in circulating activated MPs in HIVD, suggests the role of altered monocyte/macrophage trafficking and homeostasis in the pathogenesis of HIVD. This conclusion is further supported by the response of patients with HIVD to highly active anti-retroviral therapy, in which pharmacotherapeutics poorly penetrate the blood brain barrier, 1,42,43 with the concomitant reduction in circulating CD16ϩ MPs. 44 Additional studies will be necessary to elucidate the mechanisms involved in PCNA expression observed in cells of the CNS, particularly the monocyte/macrophage, and the potential role of cytokines and/or viral proteins in promoting up-regulation of this antigen.…”

Section: Discussionmentioning

confidence: 83%

Macrophage/Microglial Accumulation and Proliferating Cell Nuclear Antigen Expression in the Central Nervous System in Human Immunodeficiency Virus Encephalopathy

Fischer

Croul

Adeniyi

et al. 2004

The American Journal of Pathology

109

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This study was performed to quantitate and characterize the mononuclear phagocytes (MPs) in human immunodeficiency virus encephalopathy (HIVE) by immunohistochemistry in an effort to gain insights into potential mechanisms of central nervous system (CNS) accumulation. Single-and double-labeled studies using antibodies against CD14, CD16, CD68, proliferating cell nuclear antigen (PCNA), Ki-67, von Willebrand factor, and HIV-1 p24 were performed using brain tissue from patients with HIVE, HIV-1 infection without encephalitis, and seronegative controls. A substantial increase in MPs was observed in CNS tissue from patients with HIVE, relative to seronegative controls and patients with acquired immune deficiency syndrome but without encephalitis, as determined by CD68 and CD16 immunohistochemistry.

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Section: Discussionmentioning

confidence: 83%

Macrophage/Microglial Accumulation and Proliferating Cell Nuclear Antigen Expression in the Central Nervous System in Human Immunodeficiency Virus Encephalopathy

Fischer

Croul

Adeniyi

et al. 2004

The American Journal of Pathology

109

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“…Subsequently, widespread treatment with zidovudine (AZT) reduced the incidence of HIV dementia dramatically [68]. With the later introduction of combination therapy and PI-based highly active antiretroviral therapies (HAART), further improvement was seen [59,69]. The incidence of most HIV-related opportunistic infections, including those affecting the CNS, dropped markedly.…”

Section: Hiv Associated With Dementiamentioning

confidence: 99%

“…Survival has been greatly prolonged among patients with dementia [70]. More recently, the appearance of dementia in persons whose CD 4 counts have rebounded with ART, and the relative increase of dementia as a proportion of AIDSdefining opportunistic illnesses [59,71,72] has suggested to some that the CNS is not being treated as effectively as the lymphatic tissues.…”

Section: Hiv Associated With Dementiamentioning

confidence: 99%

Human Immunodeficiency Virus and the Central Nervous System

Mirza

Rathore

2012

Seminars in Pediatric Neurology

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The pandemic of HIV/AIDS continues to grow daily. Incident cases among women, intravenous drug users and ethnic minorities comprise the fastest growing segment of the HIV-infected population, and the number of HIV-infected individuals over the age of 50 is growing rapidly. Today, the central nervous system and the immune system are seen as main targets of HIV infection. Significant progress in the knowledge and treatment of AIDS has been obtained in recent years. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV-associated dementia (HAD), vacuolar myelopathy, and involvement of the peripheral nervous system.

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“…Study by Dore G. J. et al found that the proportion of AIDS cases with HAND increased from 5.2% in 1993-1995 (pre cART era) to 6.8% in 1996-2000 (post cART era). 6 In Indian studies Gupta J. D. et al on South Indian patients observed 60.5% had mild to moderate cognitive deficits. 7 None of the subjects had severe cognitive deficits.…”

mentioning

confidence: 98%

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

Balaini

Sharma

et al. 2017

Int J Res Med Sci

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Background: The main objective of the present work was to study the neurocognitive dysfunction in HIV positive patients and to determine its relation with CD4 count. Further, an attempt has also been made to study the relationship of neurocognitive dysfunction with cART regimen.Methods: The study was a prospective observational study, conducted over a period of one year (from July 2012 to June 2013) in the Department of Medicine in collaboration with the Department of Psychiatry at Indira Gandhi Medical College and Hospital, Shimla.Results: HIV associated neurocognitive dysfunction (HAND) was found in 39.04% patients. Mean duration from diagnosis of HIV to detection of HAND was 3.77 ± 1.7 years. Mean nadir CD4 cell count was 126.1/mm3. 39.04% patients (n=41) were found to have HIV associated neurocognitive disorder out of 105 screened patients. 95.1% patients (n=39) had asymptomatic neurocognitive impairement, 4.9% patients (n=2) had mild cognitive impairment and 2.08% patients (n=1) had HIV associated dementia. Out of 41 patients having HIV associated neurocognitive disorder, 68.3% patients (n=28) were having CD4 count less than 150. Those having CD4 count less than 150/mm3 had scored less on dementia scales indicating severe disease. 31.7% patients (n=13) were having HIV associated neurocognitive disorder (HAND) and CD4 count was more than 150/mm3.Conclusions: The conclusion of the study is that HIV associated neurocognitive disorder is common and asymptomatic neurocognitive impairement is the commonest type of HIV associated neurocognitive disorder in HIV positive patients. It can be detected while patient is asymptomatic with help of simple neurocognitive tests. Although few studies reported higher prevalence of HIV associated neurocognitive disorder among patients on certain combined antiretroviral therapy (cART) regimen but our study didn’t indicate any such association.

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Changes to AIDS dementia complex in the era of highly active antiretroviral therapy

Cited by 405 publications

References 23 publications

Macrophage/Microglial Accumulation and Proliferating Cell Nuclear Antigen Expression in the Central Nervous System in Human Immunodeficiency Virus Encephalopathy

Macrophage/Microglial Accumulation and Proliferating Cell Nuclear Antigen Expression in the Central Nervous System in Human Immunodeficiency Virus Encephalopathy

Human Immunodeficiency Virus and the Central Nervous System

HIV associated neurocognitive dysfunction and its association with CD4 count in HIV positive patients-a hospital based study

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