HIV dementia

Cognitive impairment is associated with HIV infection and AIDS. However, it is difficult to generalize about the prevalence of dementia, as the outlook for the condition varies greatly between countries where there is good health care and those where access to AIDS drugs is limited and the outlook much poorer. Regarding the UK, the predictions at the start of the epidemic of very large numbers of HIV-dementia cases have fortunately proved wide of the mark.

Nevertheless, substantial numbers of patients in the late stages of this illness do develop a frank dementing syndrome due to invasion of the brain by the HIV virus. Typical features include forgetfulness, slowness, and apathy, accompanied by motor weakness, with multiple neurological abnormalities in the later stages.

Cerebral atrophy is shown on brain scan. Treatment with antiviral agents may bring about worthwhile clinical improvement.

Differential diagnosis in the HIV-positive patient includes other cerebral infections such as toxoplasmosis, herpes simplex, and those caused by cryptococ-cus and cytomegalus; cerebral lymphoma; and depressive illness. Specific treatments are available for several of these conditions; therefore, it is desirable to reach an accurate diagnosis.

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