Georgetown University researchers reported what is thought to be the first confirmed case of Alzheimer’s disease in a HIV-positive patient, a 71-year-old man with amyloid deposits in the brain detected by a scan. The case report highlights the importance of further study into HIV-related neurological decline, and raises the possibilty that Alzheimer’s exists in other HIV-positive people but has been misdiagnosed.
The study, “An individual with human immunodeficiency virus, dementia, and central nervous system amyloid deposition,” was published in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.
Improved HIV treatments have led to better prognosis for these patients and longer lives. As the number of aging HIV-positive patients rises, diagnoses of dementia and other neurological impairments are likely to follow. Human immunodeficiency virus (HIV)–associated neurocognitive disorder (HAND) is found in 30 percent to 50 percent of patients with a long-term HIV infection, and its symptoms are similar to those of Alzheimer’s disease (AD). However, the treatment for both conditions differs. HAND patients are treated with anti-retroviral drugs that have a better chance of penetrating the brain, while Alzheimer’s patients have about a handful of approved medications to slow symptom worsening, like cholinesterase inhibitors.
In the past, clinicians thought that HIV-positive individuals were unlikely to develop Alzheimer’s, with HIV-related inflammation in the brain working to prevent the formation of amyloid plaques.
Researchers, led by neurologist R. Scott Turner, diagnosed Alzheimer’s in the HIV patient after a PET scan found the amyloid brain deposits, characteristic of individuals with mild AD. Clinical and neuropsychologic evaluations also confirmed a progressive mild dementia. Until now, five HIV-positive people have been scanned for amyloid deposits, but all scans have been negative, the researchers said.
“This patient may be a sentinel case that disputes what we thought we knew about dementia in HIV-positive individuals,” Dr. Turner, who leads the Memory Disorders Program at Georgetown University Medical Center, said in a press release.
“This case report reveals important new insights into the specific issue of HIV-related neurological impairment,” said Jeffrey Crowley, MPH, program director of the National HIV/AIDS Initiative at the O’Neill Institute for National and Global Health Law at Georgetown Law. “This finding must lead to additional population-based studies, as well as timely clinical and programmatic interventions to better support individuals with HIV who are facing neurological decline.”
According to the CDC HIV Surveillance Report, there are about 53,000 new HIV-positive cases in the U.S. every year.