A case of Parkinson’s disease?

Individuals infected with HIV are able to live longer fuller lives thanks to highly active antiretroviral therapy (HAART).

That’s what’s the journals and pharmaceutical studies report. Yet, with lower mortality rates and longer lives, comes the concern that HIV will complicate certain medical conditions, particularly those associated with cardiovascular and neurological systems.

The number one killer, regardless of HIV status, is heart disease, with over 12 million people suffering from coronary artery disease (CAD) in the United States. Over 1 million people die from cardiovascular disease each year, and roughly 25% of these deaths occur suddenly.

With regard to HIV positive individuals, heart disease and neurological issues are accelerated.

Case in point: Jimmie, is a 43 year old HIV positive male, infected 12 years ago through unprotected sex. He has been stable on HAART with a T cell count of 350 and an undetectable HIV viral load. Otherwise, Jimmie is healthy and training for a marathon. One month ago, he noted limited mobility in his left arm. Likewise, his left foot felt numb particularly after running.

On exam he has some loss of sensory perception on his left side with minimal weakness. I referred him to a neurologist who made the presumptive diagnosis of Parkinson’s disease.

Parkinson disease (PD) is a chronic, progressive neurodegenerative disorder characterized by any combination of four cardinal signs: rest tremor, rigidity, bradykinesia, and gait disturbance. An accurate diagnosis of PD rests on the clinician’s ability to recognize its characteristic signs and associated symptoms, especially in the early stages. PD generally affects the elderly not a otherwise healthy 43 year old male.

Before death, approximately 30 percent of all HIV- infected persons will develop an overt dementing illness, evident on bedside neurological examination. This illness has been referred to as AIDS dementia. An additional 30 percent of HIV-infected persons will exhibit significant cognitive abnormalities. On physical examination, these individuals often display abnormalities that are quite reminiscent of Parkinson’s disease. In very rare instances, an older person infected with HIV may be misdiagnosed with Parkinson’s disease until other AIDS-related illnesses become apparent.

HIV infects the brain very early after the initial infection. It can be demonstrated in the brain within two weeks of infection, although it rarely causes clinically apparent disorders at this stage. The virus has a predilection for deep nuclear structures, such as the basal ganglia, including the substantia nigra. This latter region is chiefly affected in Parkinson’s disease.

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2 Comments

  1. Posted January 27, 2010 at 12:26 pm | Permalink

    This is very interesting information. Is there anything someone with hiv can do to protect the brain or give it extra strength while still healthy to possibly prevent such deterioration?

    Is there anything specific one can do to protect or otherwise defend the brain from this?

    Thank you for posting this interesting information.

    Phillip

  2. spinellimd
    Posted January 27, 2010 at 12:51 pm | Permalink

    Starting HAART early, maintaining your T Cells at a higher level and suppressing HIV viral load is really all we can do. There are some studies looking at the role of supplements but nothing concrete, and neurological disease does not affect everyone with HIV.


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