Abstract

A 38-year-old female with profound motor and cognitive impairment was diagnosed with AIDS dementia complex (ADC) by neurological, radiological (MRI/MRS) and HIV RNA levels. CD4+ T cell count was 97/mm3. Therapy with zidovudine, lamivudine, and indinavir was initiated and within 2 weeks a marked improvement in mental function was seen. After 3 months the patient showed restitution of all cognitive and motor functions to baseline levels. MRI tests showed diffuse white matter pallor of both cerebral hemispheres which resolved after treatment. MRS demonstrated a decreased N-acetyl-aspartate (NAA) peak (indicative of neuronal loss) which increased during therapy. HIV CSF and plasma RNA levels were 105 and 106 copies/ml respectively which decreased to 104 and 103 copies/ml. Importantly, measurements of tumor necrosis factor (TNF)-aα, nitric oxide (NO) and quinolinic acid in plasma and CSF also diminished after treatment. Initial CSF placed on primary mammalian neurons showed neurotoxic activities. Reduction in viral load with a more profound reduction in inflammatory responses correlated with restored cognitive function consistent with metabolic encephalopathy. These data, taken together, demonstrate that HAART can reverse the profound CNS impairment associated with HIV-1 infection.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997

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Metabolic Brain Diseases
AIDS Dementia Complex
Highly Active Antiretroviral Therapy
HIV-1
Cognition
HIV
RNA
Indinavir
Quinolinic Acid
Pallor
Lamivudine
Zidovudine
Cerebrum
Therapeutics
CD4 Lymphocyte Count
Viral Load
HIV Infections
Nitric Oxide
Tumor Necrosis Factor-alpha
T-Lymphocytes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

HIV-1 dementia : A metabolic encephalopathy abrogated by highly active antiretroviral therapy (HAART). / Gendelman, Howard Eliot; Zheng, Jialin C; Ghorpade, Anuja; Rubocki, Ron; Persidsky, Yuri; Coulter, Cynthia; Hahn, Francis J.; Swindells, Susan.

In: Clinical Infectious Diseases, Vol. 25, No. 2, 01.12.1997.

Research output: Contribution to journalArticle

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