Alzheimer's Dementia in People Living With HIV

Objective Given the ageing of people living with HIV (PLWH) and the high prevalence of HIV-associated neurocognitive disorders we aimed at describing the clinical, instrumental and CSF features of PLWH diagnosed with Alzheimer's dementia (AD).

Methods The databases of 3 large Italian outpatient clinics taking care of more than 9,000 PLWH were searched for the diagnosis of AD. After obtaining patients' or their next of kin's consent for publication, anonymous data were collected in an excel spreadsheet and described. Routinely collected CSF biomarkers and radiologic imaging results were recorded whether available.

Results Four patients were included in this case series that were diagnosed with AD aged between 60 and 74 years. All participants were on highly active antiretroviral therapy and showed non-detectable serum HIV RNA. Memory impairment was the most prominent cognitive feature. The diagnosis was obtained considering the exclusion of other potential causes, magnetic resonance imaging and fluorodeoxyglucose-PET features and, in (in 2/4), CSF AD biomarkers levels. In one patient, longitudinal CSF tau/p-tau increased and beta-amyloid_1–42 decreased over time despite antiretroviral therapy containing nucleotide reverse transcriptase inhibitors.

Conclusions In older PLWH with cognitive symptoms may represent the onset of AD: a multidisciplinary team may be needed for reaching a likely in vivo diagnosis.