title: Reversible dementia in a patient with central nervous system escape of human immunodeficiency virus.
abstract: HIV-associated neurocognitive disorders (HAND) are a group of conditions ranging from asymptomatic neurocognitive impairment to disabling dementia. The clinical spectrum and pathogenesis of these disorders is changing in the era of highly active antiretroviral therapy (HAART). High levels of HIV may exist in the cerebrospinal fluid (CSF) of some patients despite suppression of serum viral loads by HAART. We report a case of a 51-year-old male with profound levels of HIV in the CSF despite low serum levels. Adjusting his HAART regimen based on HIV genotype susceptibility data and a CNS Penetrating Effectiveness (CPE) score resulted in a dramatic improvement in cognitive function. Progressive dementia in this context is a rare but emerging trend and may be reversible.
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. ibogoch@partners.org
authors.forename: Isaac I
authors.initials: II
authors.lastname: Bogoch
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Davis
authors.forename: Nagagopal
authors.initials: N
authors.lastname: Venna
mesh_terms: D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000821:virology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000821:virology; D018791:CD4 Lymphocyte Count; D003071:Cognition; D005500:Follow-Up Studies; D005838:Genotype; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000821:virology; D006679:HIV Seropositivity / Q000134:cerebrospinal fluid; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid*; D013997:Time Factors; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral