title: An individual with human immunodeficiency virus, dementia, and central nervous system amyloid deposition.
abstract: Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) is found in 30%-50% of individuals with HIV infection. To date, no HIV+ individual has been reported to have a positive amyloid PET scan. We report a 71-year-old HIV+ individual with HAND. Clinical and neuropsychologic evaluations confirmed a progressive mild dementia. A routine brain MRI was normal for age. [18F]Fluorodeoxyglucose-PET revealed mild hypermetabolism in bilateral basal ganglia and hypometabolism of bilateral parietal cortex including the posterior cingulate/precuneus. Resting state functional MRI revealed altered connectivity as found with individuals with mild AD. CSF examination revealed a low Aβ42/tau index but a low phospho-tau. An amyloid PET/CT with [18F]florbetaben revealed pronounced cortical radiotracer deposition. This case report suggests that progressive dementia in older HIV+ individuals may be due to HAND, AD, or both. HIV infection does not preclude CNS Aβ/amyloid deposition. Amyloid PET imaging may be of value in distinguishing HAND from AD pathologies.
authors.affiliation: Department of Neurology, Georgetown University, Washington, DC, USA.
authors.forename: Raymond Scott
authors.initials: RS
authors.lastname: Turner
authors.affiliation: Department of Neurology, Georgetown University, Washington, DC, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Chadwick
authors.affiliation: Department of Neurology, Georgetown University, Washington, DC, USA.
authors.forename: Wesley A
authors.initials: WA
authors.lastname: Horton
authors.affiliation: Department of Infectious Diseases, George Washington University, Washington, DC, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Simon
authors.affiliation: Department of Neuroscience, Georgetown University, Washington, DC, USA.
authors.forename: Xiong
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Georgetown University, Washington, DC, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
keywords: Alzheimer's disease; Amyloid PET; Biomarker; Dementia; Functional MRI; HAND; HIV; HIV-associated neurocognitive disorder; Human immunodeficiency virus