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Habitual prospective memory in HIV disease.

OBJECTIVE: HIV-associated neurocognitive disorders (HAND) are associated with deficits in prospective memory (PM). However, most PM research in HIV has used single-event tasks as opposed to habitual PM paradigms, which may be more relevant to clinical populations for whom many health-care behaviors must be performed both frequently and routinely. METHOD: For the current study, we examined habitual PM and its associations with real-world functioning outcomes in 36 HIV+ individuals with HAND (HAND+), 70 HIV+ individuals without HAND (HAND-), and 115 HIV- individuals. The ongoing task consisted

[Acute psychosis as a side effect of efavirenz therapy with metabolic anomalies: an important differential diagnosis of HIV-associated psychoses].

Among patients with human immunodeficiency virus (HIV) infections psychiatric disease poses a particular challenge for caregivers. Neuropsychiatric side effects of efavirenz have been described in up to 40% of patients showing dizziness, insomnia, unusual dreams, mood instability, personality alterations and thought disorders. In immigrants from Africa and South America these side effects may be related to elevated plasma concentrations of efavirenz due to polymorphisms of cytochrome P450 isozymes (especially G516T). Alleles for these polymorphisms are more frequent in African and South Americ

Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND.

Although HIV-associated dementia (HAD) occurs in less than 5 % of individuals with access to combination antiretroviral therapy, rates of milder forms of HIV-associated neurocognitive disorder (HAND) are much higher. We sought to define an optimal cut point for the International HIV Dementia Scale (IHDS) in Thailand for the identification of symptomatic HAND, defined as both HAD and mild neurocognitive disorder. We then sought to determine if adding a simple test from a larger neuropsychological battery could improve the performance characteristics for identifying symptomatic HAND. In this stu

Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya.

OBJECTIVE: To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD) for use by primary health care workers (HCW) which would be feasible to implement in resource-limited settings. BACKGROUND: In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests.

Further characterization of the spatial learning deficit in the human immunodeficiency virus-1 transgenic rat.

Human immunodeficiency virus (HIV)-associated dementia (HAD) encompasses a spectrum of cognitive and motor deficits resulting from the progression of central nervous system abnormalities caused by the HIV-1 virus. With the advent of highly active antiretroviral therapy (HAART), these deficits have become milder, but more prevalent as the population of HIV-positive individuals ages. Mild impairment in cognition has also been identified in asymptomatic HIV-1 patients. The noninfectious HIV-1 transgenic (Tg) rat recently developed to study the pathogenesis of acquired immunodeficiency syndrome (A

Assessment of neuroAIDS in the international setting.

The global burden of the HIV epidemic is staggering, but in the short term, it is largely unfelt in the developed world. Almost one million people have been infected with HIV in North America, and the results of effective antiretroviral therapy have dramatically improved survival and quality of life. However, there are 25 million infected in sub-Saharan Africa alone, and antiretroviral treatment is scarce. Ninety-five percent of new infections occur in the developing world where resources are limited. Very little is known about NeuroAIDS in the developing world where few studies have been cond

Neuroimmunity and the blood-brain barrier: molecular regulation of leukocyte transmigration and viral entry into the nervous system with a focus on neuroAIDS.

HIV infection of the central nervous system (CNS) can result in neurologic dysfunction with devastating consequences in a significant number of individuals with AIDS. Two main CNS complications in individuals with HIV are encephalitis and dementia, which are characterized by leukocyte infiltration into the CNS, microglia activation, aberrant chemokine expression, blood-brain barrier (BBB) disruption, and eventual damage and/or loss of neurons. One of the major mediators of NeuroAIDS is the transmigration of HIV-infected leukocytes across the BBB into the CNS. This review summarizes new key fin

Soluble cerebrospinal fluid factors induce Ca2+ dysregulation in rat cultured cortical astrocytes in HIV-1-associated dementia complex.

OBJECTIVES: To investigate the effect of cerebrospinal fluid (CSF) of HIV-1-seropositive patients with and without HIV-1-associated dementia complex (HADC) on the intracellular Ca2+ regulation of cultured cortical astrocytes. DESIGN: In a blinded study the effects of CSF samples from HADC patients and from HIV-1-seropositive but not demented patients on intracellular Ca2+ regulation of cultured cortical astrocytes were investigated. Astrocytes were chosen because they contribute to both electrophysiological and immunological processes within the brain. METHODS: Astrocytes were incubated in C

Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years.

OBJECTIVES: To describe changes in HIV-associated neurocognitive impairment in patients treated with highly active antiretroviral therapy (HAART) for at least 3 years. METHODS: Prospective, observational study of comprehensive neuropsychologic (NP) testing, neurologic examination, and laboratory measures before HAART and after 6, 15 and 45 months of HAART, on 28 consecutive patients seen in our department since April 1996. RESULTS: At baseline, 16 patients were neurocognitively impaired and 12 were not. Among the 16 impaired patients, 5 patients failed to meet the criteria for impairment aft

Active HIV-1 redistribution and replication in the brain with HIV encephalitis.

The central nervous system (CNS) is of particular importance in human immunodeficiency virus type 1 (HIV-1) infection. First, the CNS may be difficult to access for anti-retroviral treatment and may become a sanctuary for residual viruses. Second, HIV-1 infection may lead to AIDS dementia complex (ADC) culminating in HIV-1 encephalitis. In order to examine the pattern of drug resistance and the role of encephalitis in enhancing viral redistribution to the CNS, we compared pol gene quasispecies of the spleen and brain in two patients with and two patients without HIV-1 encephalitis, who had bee…

Psychiatric morbidity in HIV patients.

OBJECTIVE: To provide an accessible source of clinical information related to the diagnosis and treatment of psychiatric morbidity associated with HIV infection. METHOD: A selective MEDLINE literature search was used to identify 225 relevant articles, 67 of which were selected for inclusion based upon the presence of psychiatric morbidity. Psychiatric morbidity was defined by the presence of a DSM-IV diagnostic code reflecting psychiatric illness. RESULTS: HIV-infected patients have high rates of psychiatric morbidity. CONCLUSION: The psychiatric evaluation and treatment of psychiatric morb

HIV-related neuropsychological impairment and immunodeficiency. CD8+ lymphocytes and neopterin are related to HIV-encephalopathy.

The relationship between neuropsychological test performance and immunological parameters was studied in 52 HIV-positive patients within different stages of the infection. All subjects were neuropsychologically tested, the CD4+ and CD8+ lymphocyte count were measured in peripheral blood, and the concentration of neopterin and HIV-p24 antigen were measured in serum. Ten patients with AIDS were defined as neuropsychologically impaired. The CD8+ cell count was the only immunological parameter that could significantly discriminate between AIDS patients with and without neuropsychological impairmen

Indications for stereotactically-aided differential diagnosis: the neurologist's view.

The contribution of stereotactic biopsy (SB) in three pathological conditions; neoplastic disease, immunodeficiency states and degenerative cerebral atrophy, is reviewed. When craniotomy is contraindicated, SB is the most reliable method for demonstrating the neoplastic nature and the degree of malignancy of an intracranial space occupying lesion and may help to delineate it limits. In immunodepressed patients, SB is frequently used to differentiate tumours from opportunistic infections. In degenerative dementia, SB is susceptible of differentiating Alzheimer's disease from other degenerative

Acoustically evoked event-related potentials in HIV-associated dementia.

Cognitive event-related potentials (ERPs) were recorded in 33 HIV-positive individuals with clinical signs of dementia (group C) using an auditory oddball paradigm, in comparison to a healthy control group of comparable education and social environment (group A) and to a cohort of clinically asymptomatic HIV-positive individuals (group B). Parameters evaluated were: N1, P2, N2 and P3 latencies and N1-P2, P2-N2 and N2-P3 amplitudes. Results of group B and C were correlated with clinical findings, test psychometric performance and standard EEG records of both groups. The demented patients reveal

Asymptomatic and neurologically symptomatic HIV-seropositive individuals: prospective evaluation with cranial MR imaging.

As part of a prospective multidisciplinary study of individuals seropositive for the human immunodeficiency virus (HIV), cranial magnetic resonance (MR) imaging was performed on 119 HIV-seropositive subjects (95 asymptomatic, 24 symptomatic) and the results were correlated with clinical data. MR images regarded as positive included those showing atrophy and/or white matter lesions. On the basis of these criteria, 96 subjects had normal MR images and 23 had abnormal images. Results of chi 2 analysis revealed a statistically significant difference between the asymptomatic group (12 of 95 [13%] w

Aciclovir protects against quinolinic-acid-induced oxidative neurotoxicity.

AIDS-related encephalopathy, including AIDS dementia complex (ADC) and the opportunistic disease, herpes simplex encephalitis (HSE), are postulated to arise due to the release of neurotoxic products, such as quinolinic acid (QUIN), by activated microglial cells in the brain. QUIN causes a cascade of events to occur, which leads to the production of reactive oxygen species (ROS), these being ultimately responsible for oxidative neurotoxicity. The antiherpes antiviral aciclovir has been reported to protect against neuron loss in HSE, but the mechanism for this neuroprotection is unknown. Therefo…

Short echo-time proton magnetic resonance spectroscopy in regions of severe HIV-related diffuse white matter abnormality on MRI.

The purpose of this study was to determine whether short echo-time proton magnetic resonance spectroscopy (H-MRS) could detect mobile lipid resonances attributable to myelin breakdown products in the deep cerebral white matter of patients with AIDS who have severe diffuse/patchy white matter hyperintensity on T2-weighted magnetic resonance imaging (MRI). Seven patients with AIDS and clinical HIV-associated dementia complex (HADC) and 12 male controls were studied at 1.5T using a single 8 ml voxel, gradient localised, stimulated echo acquisition mode (STEAM) spectroscopy sequence. Spectra were

Болезнь белой материи в СПИДе: результаты снимков в MR.

Анализ изображений магнитного резонанса (MR) 365 пациентов с синдромом приобретенного иммунодефицита (СПИД) показал, что 112 (31 процент) имеют аномалии сигнала, связанные с белым веществом. Были отмечены четыре модели: a) диффузия: широкое участие большого района; b) разрозненность: локализованное участие с нечетко определенными диапазонами; c) центральная: четко определенные области участия; и d) пробт: маленькая фаси диаметром менее 1 см. Клинические или патологические данные были получены у 60 из 112 пациентов и были увязаны с образцами белой материи, наблюдаемыми на изображениях MR. Диффу

Совпадение в аннотации оригинала
A review of the magnetic resonance (MR) images of 365 patients with acquired immunodeficiency syndrome (AIDS) revealed that 112 (31%) had si … re correlated with the white matter patterns seen on MR images. The diffuse pattern correlated with AIDS dementia complex (ADC), which was the most common clinical diagnosis. Patchy or punctate lesions may be seen with ADC but are less common. Focal white matter lesions were not seen in patients with ADC but were seen in all six patients with progressive multifocal leu …

Impact of opportunistic disease on survival in patients with HIV infection.

OBJECTIVE: To assess the impact of opportunistic diseases on survival in patients with HIV disease. METHODS: A cohort of 2081 patients followed for a mean of 30 months was studied. Time-dependent Cox proportional hazards analyses were performed using incident opportunistic diseases and CD4 cell counts as independent variables. RESULTS: During follow-up, 730 (35%) patients died. The occurrence of Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV) disease, Mycobacterium avium complex (MAC) disease, Candida esophagitis, Kaposi's sarcoma, lymphoma, progressive multifocal leukoencephalop

MR spectroscopy and diffusion-weighted MR imaging in focal brain lesions in AIDS.

Focal brain lesions in AIDS may be difficult to diagnose with conventional imaging techniques. Recent advances in magnetic resonance (MR), including MR spectroscopy (MRS) and diffusion-weighted imaging (DWI), may provide additional information in the evaluation of these diseases. MRS of various AIDS brain lesions show distinct chemical profiles; however, several factors such as location of the voxel, echo time of the study, and disease stage, all have to be taken into consideration when interpreting the results of MRS. DWI demonstrates molecular motion within the tissue and may provide informa