Introduction:
When the virus attacks the brain, mental health can be affected, and intellectual problems can prevail in HIV (Human Immunodeficiency Virus) encephalopathy. When the brain swells due to HIV infection, it is called HIV encephalopathy. It is also known as AIDS dementia complex and HIV-associated dementia. HIV can reach the brain quickly following illness, but HIV encephalopathy usually occurs in the advanced stage, thus identifying it as an AIDS-defining condition.
What Are the Stages of HIV Encephalopathy?
The symptoms of HIV encephalopathy usually start mild and worsen with time. The following are the stages of the condition:
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Stage 0 - The mental and motor functions appear normal.
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Stage 0.5 (Subclinical) - There might be a few symptoms at this stage, like slowed arm and leg movements and deteriorated ocular (eye) movements. One can carry out their usual activities since walking and strength remain normal.
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Stage 1 (Mild) - The intellectual, motor, and functional impairments are evident at this stage and can be confirmed through neuropsychological testing. One can continue to walk without any assistance and can perform the most necessary activities of daily life.
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Stage 2 (Moderate) - The individuals in this stage can perform their daily activities, but their thinking ability deteriorates, and they cannot do any challenging daily activities. These individuals can walk around with the help of a supportive cane.
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Stage 3 (Severe) - One is no longer able to carry out any day-to-day work at this stage, and the intellectual capacity is affected to a great extent. Walking alone, conversing with others, and moving their arms can be challenging for individuals at this stage. One might require an assistive device like a walker to move around.
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Stage 4 (End-Stage) - The intellectual, social comprehension, and output drops to a very basic level at this stage, and one only talks a little. Some or all the limbs may get paralyzed, and the individual remains unresponsive or unaware. One might also suffer from urinary and fecal incontinence.
What Are the Causes of HIV Encephalopathy?
HIV encephalopathy occurs in the advanced stage of HIV, and its occurrence is rare in people undergoing antiretroviral therapy (treatment of HIV patients using anti-HIV drugs). The exact reasons for the incidence of HIV encephalopathy are unknown, and researchers are pondering the same. However, some evidence suggests the following:
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Damage and inflammation to the brain can occur when the virus crosses the blood-brain barrier through blood lymphocytes (immune cells), monocytes (a type of white blood cell), or endothelial cells (lining of blood vessels).
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CD4 T-cells are a kind of white blood cells that help fight against infections. HIV encephalopathy can occur in individuals with a low CD4 count.
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The swelling of the brain in this condition can impact the brain volume and structure, leading to cognitive and memory issues and eventually resulting in dementia (a group of symptoms that affect thinking, memory, and social abilities).
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HIV can mutate (multiply) in the brain, unlike its behavior circulating in the blood. This can affect the efficacy of specific treatments.
What Are the Symptoms of HIV Encephalopathy?
The following are the symptoms:
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Memory loss.
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Deterioration in the thinking ability.
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Difficulty concentrating.
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Irritability.
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Personality changes.
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Poor coordination (loss of motor skills).
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Difficulty in walking and carrying out daily activities.
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Social withdrawal.
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Cannot speak clearly.
How Can HIV Encephalopathy Be Diagnosed?
It is found that the occurrence of HIV-associated neurocognitive disorders may be more than 50 percent, especially among the elderly. One can find it challenging to take the medications as per the physician's directions when there is a cognitive impairment. Hence, it is essential to monitor HIV progression and report to the healthcare professional if one detects any new symptoms. Cognitive impairment can also be due to other factors like neurological disorders, other types of encephalopathy or infections, or due to psychiatric disorders.
There is no definitive test to diagnose HIV encephalopathy. The diagnosis begins with a detailed history taken by the physician based on the existing symptoms, and the physician might suggest the following blood tests:
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Liver function.
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Blood glucose.
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CD4 count and viral load.
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Vitamin B12 levels.
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Total protein levels.
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Thyroid hormone.
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Toxoplasmosis (a disease that occurs due to an infection with the Toxoplasma gondii parasite).
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Cytomegalovirus (CMV).
Other tests include:
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Electroencephalogram (EEG) to assess the electrical activity of the brain.
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Mental status and neuropsychological testing to assess mood, behavior, and cognitive function.
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CT (computed tomography) or MRI (magnetic resonance imaging) scan to detect brain atrophy (decrease in size of a body part), cerebrovascular disease (conditions that affect the blood flow to the brain), and neurologic disorders.
Cerebrospinal fluid studies like spinal tap or lumbar puncture may be suggested to identify the following:
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Brain hemorrhage (bleeding).
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Cryptococcal antigen.
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Lymphocytic pleocytosis (abnormal increase of lymphocytes in the cerebrospinal fluid).
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Other infections in the brain or spinal cord.
How Can HIV Encephalopathy Be Treated?
There is no permanent cure for HIV encephalopathy, but the symptoms can be managed. The treatment plan can be customized based on age, overall health, medical history, stage of progression of the condition, and other complications, if any. The following are a few treatment methods:
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Antiretroviral Therapy: Antiretroviral drugs can decrease the number of viruses circulating in the body, which can retard the progression of the disease. It also helps improve the symptoms of dementia. Highly active antiretroviral therapy (HAART) includes a combination of at least three of these drugs.
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Treatment of Mental Health: One or more antidepressants, antipsychotics, or stimulants may be prescribed to treat depression, lethargy, and psychosis.
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Substance Abuse Counseling: Since alcohol or drug misuse can worsen dementia, substance abuse counseling can be given to these patients.
The success of antiretroviral therapy on milder forms of HIV-related cognitive impairment is questionable since the cognitive impairments in such cases are so mild that they get failed to be diagnosed at times.
What Are the Home Care Strategies for People With HIV Dementia?
The strategies include:
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A daily routine has to be charted so that one can remember their daily tasks.
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Maintaining notes and lists and writing down things can aid one in remembering and keeping details organized.
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The medicines can be kept in boxes with the dates and the time to be taken mentioned on the package so that it is easy to take the medications and avoid retaking them.
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Exercising regularly and following a healthy diet can keep one fresh and cheerful.
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Things at home should be kept in a familiar place, and even other family members should work on replacing the items in their original place to make it easy for individuals with dementia.
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Staying active, socializing with friends, and engaging in things one enjoys work out well for people with dementia.
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Relaxation techniques like meditation, massage, or deep breathing can be followed.
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Since communication can be difficult for people with HIV encephalopathy, friends and family members can make eye contact with the person before initiating a conversation. They must also talk slowly as well as maintain a respectful tone.
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Multi-tasking should be avoided. Instead, one task should be carried out at a time.
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Those who are aware of HIV encephalopathy should extend their help to those suffering from this condition and ask them in what way they can be helpful.
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Certain arrangements can be made prior so that they may be helpful in the future, like housekeeping and transportation services, child care and pet care, and skilled healthcare or personal care services.
Is It Possible to Prevent HIV Encephalopathy?
People on antiretroviral therapy to control HIV are least prone to develop HIV encephalopathy. Research has revealed that less than five percent of individuals under antiretroviral therapy developed HIV encephalopathy. This finding shows that one should start with antiretroviral treatment immediately following an HIV diagnosis to prevent the occurrence of HIV encephalopathy.
Conclusion:
HIV encephalopathy is one of the severe complications of HIV infection. This condition has no permanent cure, but the treatment is based on the symptoms. If left untreated, HIV-related dementia can cause death within three to six months, which is also influenced by other factors. As the condition worsens, one can find it challenging to perform their daily activities and their quality of life. Highly active antiretroviral therapy (HAART) is a good remedy and can extend the life expectancy of those who have HIV and HIV-related dementia. Being on antiretroviral therapy right after the diagnosis of HIV can help prevent the transition of the disease to HIV encephalopathy.
