• 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
    Immune system white blood cell
    HIV destroys white blood cells vital to the immune system.
    Copyright © Nucleus Medical Media, Inc.

    Causes

    It is not clearly understood how HIV infection causes ADC.

    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:

    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.

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