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.

Differentiating HIV-Associated Neurocognitive Disorders From Alzheimer’s Disease: an Emerging Issue in Geriatric NeuroHIV

“…[48] Two case reports of AD in patients with HIV have been documented, each highlighting the risk for delayed diagnosis and distinguishing factors on neuropsychological testing patterns as well as progression triggering concern for concurrent AD. [5, 49]…”

“…While CSF biomarkers were equivocal (low Ab 42 /tau index, consistent with AD and a low phospho-tau, indeterminate for AD), an amyloid PET/CT with florbetaben confirmed a pattern of amyloid deposition consistent with AD, leading the authors to conclude a mixed AD/HAND diagnosis. [5]…”

HIV-associated neurocognitive disorder

“…[41] Remarkably, only recently was the first Alzheimer’s disease in an HIV positive patient reported, suggesting that there is not a marked interaction of the pathophysiology of these conditions. [42] However, given the aging HIV population, and hoped for AD therapies on the horizon, it will become important to verify biomarker means to differentiate AD from HAND in the future. Indeed, it appears likely that CSF profiles and amyloid imaging developed for AD detection will be useful in differentiating these disorders.…”

Viruses in human central nervous system — invasion, transmission, and latency: a literature review

“…Вирусы герпеса обнаружены в обонятельной луковице, гипоталамусе, гиппокампе, миндалине. Активно накапливаются доказательства в пользу предположения о возможности участия вирусов не только в воспалительных процессах в ЦНС, но и возникновении нейродегенеративных, опухолевых, сосудистых заболеваний [84][85][86][87][88]. Так, по данным полногеномных исследований различных неврологи-ческих заболеваний показано, что 7 дифференциально экспрессирующихся генов (CTSS, PTX3, CHI3L1, Mx1, CXCL16, BIRC3, BST2) при заражении HHV6A астро-цитов человека HA1800 также дифференциально экспрессируются при нескольких неврологических заболеваниях [89].…”

“…В настоящее время новые технологии исследо-вания жизненного цикла вирусов и метаболических аспектов их взаимодействия с клеткой хозяина, в том числе интравитальное наблюдение за жизнедеятель-ностью клетки, культивирование нейронов, секвени-рование генома единственной клетки, использование в качестве экспериментальных животных гумани-зированных мышей, активно внедряются в лабора-торную практику, что способствует исследованию механизмов участия вирусов в формировании таких заболеваний, как болезнь Альцгеймера, рассеянный склероз, глиома [84][85][86][87][88].…”