AIDS Dementia Complex
AIDS Dementia Complex Definition
AIDS Dementia Complex (ADC) is one of the most common complications of HIV-1 infection. It is severe and is greatly associated with high morbidity. Its pathogenesis is still a mystery although as compared with other opportunistic infections of HIV, it is believed to be caused directly by the HIV-1 virus. ADC was first seen alongside the AIDS epidemic. As with the term, there is the persistent cognitive deterioration which not only affects the intellect of the patient but including the motor complex and behavior. Also, myelopahty is an important aspect of the ADC. The moment the patient is diagnosed with the ADC, it is staged according to the ADC Staging System. The staging is composed of five steps which are based on the cognitive and motor incapacity of the patient. The earlier stage is when there are neurologic symptoms but without the functional impairment and the advanced stage is when there is severe dysfunction. Generally, ADC affects the patient's cognition, motor skills and behavior. Usually the cognitive and motor skills are the first ones affected and the diagnosis is usually made when the patient manifest impairment of these skills. In a study conducted on the ADC, it was found that ADC is commonly found for those with advanced HIV-1 infection although it is also commonly found in those with preserved helper lymphocyte. This means that immunosuppression has an effect on the development of the complex. According to the data by the Community Programs for Clinical Research on AIDS (CPCRA), ADC is strongly associated with the advanced stage of HIV. Moreover it also showed that there is strong relationship between survival rate and the development of stage 2 and over of ADC. Compared with the mortality rate of Pneumocystic carinii pneumonia, the 6-months cumulative mortality rate of ADC is three times greater. Compared with other neurologic diseases it is almost the same is the 85% rate if PML, 70% of CNS lymphoma and 51% of cerebral toxoplasmosis. The high rate may be attributed to ineffectiveness of antiviral treatment, the vulnerability of neurologic debility and the hopelessness attitude of the caregivers. According to the most recent studies the HIV-1 plays a significant role in the development of ADC particularly those with severe cognitive dysfunction. It was found that it is due to the production of the macrophages and microglia by the HIV-1, which affects the neuronal dysfunction. There is also the activation of the cytokine circuits and the neuropahtologic sequelae which causes neurotoxicity. By identifying these factors doctors may soon find effective treatment for ADC.