HIV-1 dementia: A metabolic encephalopathy abrogated by highly active antiretroviral therapy (HAART)

Howard Eliot Gendelman, Jialin Zheng, Anuja Ghorpade, Ron Rubocki, Yuri Persidsky, Cynthia Coulter, Francis J. Hahn, Susan Swindells

Research output: Contribution to journalArticlepeer-review


A 38-year-old female with profound motor and cognitive impairment was diagnosed with AIDS dementia complex (ADC) by neurological, radiological (MRI/MRS) and HIV RNA levels. CD4+ T cell count was 97/mm3. Therapy with zidovudine, lamivudine, and indinavir was initiated and within 2 weeks a marked improvement in mental function was seen. After 3 months the patient showed restitution of all cognitive and motor functions to baseline levels. MRI tests showed diffuse white matter pallor of both cerebral hemispheres which resolved after treatment. MRS demonstrated a decreased N-acetyl-aspartate (NAA) peak (indicative of neuronal loss) which increased during therapy. HIV CSF and plasma RNA levels were 105 and 106 copies/ml respectively which decreased to 104 and 103 copies/ml. Importantly, measurements of tumor necrosis factor (TNF)-aα, nitric oxide (NO) and quinolinic acid in plasma and CSF also diminished after treatment. Initial CSF placed on primary mammalian neurons showed neurotoxic activities. Reduction in viral load with a more profound reduction in inflammatory responses correlated with restored cognitive function consistent with metabolic encephalopathy. These data, taken together, demonstrate that HAART can reverse the profound CNS impairment associated with HIV-1 infection.

Original languageEnglish (US)
Pages (from-to)457
Number of pages1
JournalClinical Infectious Diseases
Issue number2
StatePublished - 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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