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

    Factors that may increase your chance of having ADC include:
  • Symptoms

    Symptoms usually develop slowly and worsen over time. They can be grouped into stages:
    Stage 1 (Mild)
    • Difficulty concentrating
    • Difficulty remembering details, such as phone numbers, appointments, or 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, such as eating or 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 disorders, such as psychosis or mania
    • Unable to leave bed
  • 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 medication plan that is right for you. These drugs are often given in combination.
    Other Medications
    Other medications may be used along with antiretroviral therapy to treat symptoms of ADC. These may include:
    • Antipsychotics
    • Antidepressants
    • Anti-anxiety medications
    • Stimulants
    • Mood stabilizers
    • Medications to prevent seizures
  • Prevention

    ADC occurs in people with HIV. Ways to help reduce your chance of getting HIV include:
    • When you have sex, use a male latex condom.
    • Limit your number of sexual partners.
    • Avoid sexual partners who are HIV-infected.
    • 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, such as razors or toothbrushes.
      • Carefully handle and properly dispose of needles used for medication.
  • RESOURCES

    American Foundation for AIDS Research http://www.amfar.org

    AIDS.gov - U.S. Department of Health and Human Services http://www.aids.gov

    CANADIAN RESOURCES

    AIDS Committee of Toronto http://www.actoronto.org

    Canadian AIDS Society http://www.cdnaids.ca

    References

    AIDS dementia complex. University of California at San Francisco website. Available at: http://hivinsite.ucsf.edu/InSite?page=id-01-08. Accessed September 4 ,2013.

    HIV-associated dementia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated March 7, 2013. Accessed September 4, 2013.

    Luo X, Carlson KA, 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, et al. Textbook of Neurological Surgery. 6th ed. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2011: chap 46.

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