HIV dementia and HIV-related brain impairment (HRBI) - PowerPoint PPT Presentation

About This Presentation
Title:

HIV dementia and HIV-related brain impairment (HRBI)

Description:

... due to JC virus Cerebral toxoplasmosis Herpes simplex virus encephalopathy Cryptococcal meningitis Cerebral lymphoma other infections eg TB meningitis ... – PowerPoint PPT presentation

Number of Views:187
Avg rating:3.0/5.0
Slides: 17
Provided by: Jean329
Category:

less

Transcript and Presenter's Notes

Title: HIV dementia and HIV-related brain impairment (HRBI)


1
HIV dementia andHIV-related brain impairment
(HRBI)
  • Jeanette Meadway FRCP
  • Consultant Physician
  • Mildmay Hospital UK
  • Hackney Road, London E2 7NA

2
What is HIV dementia?
  • An AIDS-defining illness with WHO definition
    (ICD10)
  • Objectively defined decline in recent memory
  • Evidence of HIV infection
  • Exclusion of opportunistic infections, tumours or
    other brain disorders
  • Absence of acute brain syndrome (delirium)

3
HIV dementia - cause
  • HIV affecting the brain
  • No HIV in nerve cells (neurons)
  • HIV in macrophages and glial cells
  • Damage due to increased cytokines?
  • Damage due to toxic effects of HIV envelope
    protein gp120?
  • Damage leads to cell apoptosis (cell death) and
    structural changes

4
(No Transcript)
5
Diagnosis of HIV dementia
  • Function cognitive impairment, motor
    dysfunction, behavioural changes
  • HIV disease usually advanced with low CD4
    (lt200), high viral load, no ARV treatment or
    inadequate ARVs despite deterioration
  • CT and MRI scans show brain shrinkage and white
    matter changes

6
MRI changes
  • Brain shrinkage rim of CSF inside skull,
    flattened gyri
  • White matter changes, most likely to affect
    frontal lobes as in this scan
  • (contrast medium in ventricles)

7
What is HIV-related brain impairment?
  • Not a diagnosis, an assessment of function which
    is useful for rehabilitation
  • Cognitive dysfunction (- behaviour change and
    motor dysfunction) due to HIV-related pathology
  • Includes HIV-related illnesses causing cognitive
    impairment
  • Does not include unrelated brain impairment in an
    HIVve person eg due to alcohol
  • The same diagnoses are not included in HRBI if
    there is no cognitive dysfunction

8
Why this definition of HRBI?
  • The conditions which lead to behavioural
    problems, cognitive impairment and motor problems
    in the context of advanced HIV offer the same
    challenge for rehabilitation
  • All are likely to benefit from supervised
    adherence to ARVs, multidisciplinary approach to
    social skills and other rehabilitation

9
HRBI diagnoses
  • HIV dementia
  • PML (progressive multifocal leukoencephalopathy)
    due to JC virus
  • Cerebral toxoplasmosis
  • Herpes simplex virus encephalopathy
  • Cryptococcal meningitis
  • Cerebral lymphoma
  • other infections eg TB meningitis

10
Cerebral toxoplasmosis
  • When CD4 low toxoplasma causes a cerebral abscess
  • When contrast is injected, there is high uptake
    around the abscess a ring-enhancing lesion
  • Toxoplasma may cause cognitive impairment

11
Cryptococcal Meningitis
  • Cryptococcal meningitis is more insidious than
    bacterial meningitis
  • Varied neurological changes occur eg cognitive
    impairment

12
PML
  • Progressive without treatment deteriorating
    neurology and death
  • Multifocal affects separate parts of the brain,
    as seen with 3 in this scan
  • Leuko affects white matter

13
HRBI rehab at Mildmay
  • Patients accidentally rehabbed at first
  • Those improving had full effective ARVs and full
    multidisciplinary team involvement
  • Emphasis on self-medication programme, relearning
    social skills and skills to allow independent
    activity
  • Some patients return to live independently
  • Behavioural improvements allow more appropriate
    placements for most patients

14
A new type of dementia
  • A patient restarted on ARVs later deteriorated
    and died despite fully controlled viral load and
    good CD4
  • PM showed no HIV in brain, no other infections or
    tumours, and vacuolated cells
  • This may be immune reconstitution syndrome
  • Occurs only in a minority of patients

15
Summary - HRBI
  • Cognitive - behavioural and motor impairment due
    to HIV disease
  • Occurs only in advanced HIV
  • Most improve with full regular ARVs
  • Improvement with rehab team input
  • Rehab allows easier placement and improved
    quality of life
  • Deterioration on ARVs is uncommon

16
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com