First-of-its-Kind Case May Change How We View HIV-Related Dementia

It was back in April that researchers from Georgetown University reported the first case of Alzheimer’s disease in a person living with the human immunodeficiency virus (HIV). Now the case report will be presented at the Alzheimer’s Association International Conference (AAIC) 2016 in Toronto, Canada on July 27.

“This patient may be a sentinel case that disputes what we thought we knew about dementia in HIV-positive individuals,” R. Scott Turner, MD, PhD, a neurologist at Georgetown University Medical Center (GUMC), said in a news release.

Turner had diagnosed the HIV-positive 71-year-old man with Alzheimer’s after a PET scan showed deposition of amyloid in the brain. Since HIV causes inflammation in the brain, and may prevent amyloid clumps from forming, it was believed that people with the condition may not develop Alzheimer’s.

• Related: Early HIV Infection Commonly Yields Neurologic Problems

About 30% to 50% of people with long-term HIV will go on to develop HIV-associated neurocognitive disorders (HAND). However, this first case of Alzheimer’s implies that patients could have being diagnosed with HAND while it’s really Alzheimer’s. But going a step beyond that, Turner explained that a patient could have a HAND-Alzheimer’s mix — leading to progressive dementia.

“The medical community assumes that dementia with HIV is caused by HAND. Physicians haven’t considered Alzheimer’s, so it’s possible that a number of older HIV-positive individuals may be misdiagnosed,” explained Turner, who also leads the Memory Disorders Program at GUMC.

But these findings have another implication — patients with HIV can live to reach Alzheimer’s onset age. That’s a huge improvement from the death sentence HIV was just 30 years ago. Up until this point, there were five documented cases of people with HAND who have undergone amyloid PET imaging – the oldest being 67 years old. All of the results came back negative, however, the number of people with HIV diagnosed with dementia is on the rise – especially in those 55 and older.

Currently, there are four drugs approved by the US Food and Drug Administration (FDA) to treat Alzheimer’s and antiretroviral medications are prescribed for HAND. So needless to say, physicians need to know which condition their patients have in order to advise the correct form of treatment.

The findings were published in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

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