Background: Antiretroviral treatment (ART) can decreased the incidence of HIV dementia, but milder cognitive impairment may not resolve when patients receive ART. In Indonesia, cognitive screening of HIV patients is not routinely performed before starting ART. Here we assess cognitive impairment in ART- naïve HIV patients beginning treatment in Jakarta. Methods: This is a cross sectional study with inclusion criteria: HIV positive, ART naïve, CD4 T-cells below 200 cells/uL, Karnofsky Performance Score (KPS) above 70. HIV-associated neurocognitive disorder (HAND) was defined by performance at least 1 Standard Deviation (SD) below the mean of demographically adjusted normative scores in at least two cognitive areas. Results: We studied 82 subjects with median (range) age 31 (19-48) years. Fifty six subjects (68%) were males. HAND was found in 42 subjects (51%). Eight subjects (19%) had impairment in 4 domains, 15 subjects (36%) in 3 and 19 (45%) in 2. The most common domain affected was memory (63%). Conclusion: Our results show the prevalence of HAND is high among HIV naïve patients in Jakarta. This establishes the need for screening of cognitive function before initiating ART.
AIDS Dementia Complex ; HIV

Humans ; AIDS Dementia Complex/pathology* ; HIV Infections

We report a 33-year-old man with AIDS dementia complex, which is one of the most common neurologic complica-tion of HIV-1 infection. The man presented with mild psychomotor slowing and episodic loss of consciousness about 5 years after the detection of the HIV-1 infection. His symptoms included forgetfulness, concentration difficulties, apathy, and psychomotor retardation which progressed rapidly evolving into the characteristic features of terminal HIV-1-asso-ciated dementia complex, such as severe dementia, mutism, incontinence, and paraparesis before death. Brain MRIrevealed diffuse confluent high signal intensity lesions in the subcortical white matter on the T2 weighted image. HIV encephalitis (AIDS dementia complex) was confirmed by a brain autopsy.
Acquired Immunodeficiency Syndrome ; Adult ; AIDS Dementia Complex* ; Apathy ; Autopsy* ; Brain ; Dementia ; Encephalitis ; HIV ; HIV-1 ; Humans ; Mutism ; Paraparesis ; Unconsciousness

OBJECTIVETo clone and express the HIV-1B gp120 genes isolated at different organizations from a patient died of AIDS dementia complex (ADC) in eukaryotic cells.

METHODSUsing the genomic DNA isolated from peripheral lymphnodes, choroid plexus and occipital white matter from a patient died of ADC as the template, HIV-1B gp120 gene was amplified with PCR. After sequenced, HIV-1B gp120 was inserted into pcDNA3.1 (+) and recombinant expressing vector gp120/pcDNA3.1 (+) was constructed succeffuly confirming with sequencing. Then expressing vector was transfected into eukaryotic cells U87 using liposome transfection and expression of HIV-1B gp120 gene was assayed with indirect immunofluorescence.

RESULTSHIV-1B gp120 genes isolated from peripheral lymphnodes, choroid plexus and occipital white matter of the ADC patient were successfully cloned and recombinant expressing vector gp120/pcDNA3; 1 (+) could express envelope glycoprotein HIV-1B gp120 in U87 cells.

CONCLUSIONAll the HIV-1B gp120 gene isolated at the different organizations of the same ADC patient could express in U87 cells, which may supply a valuable basis for studying the neurotoxicity and neurotoxic mechanism of HIV-1 gp120 protein.

AIDS Dementia Complex ; virology ; Cloning, Molecular ; HIV Envelope Protein gp120 ; biosynthesis ; genetics ; toxicity ; Humans ; Recombinant Proteins ; biosynthesis ; Sequence Analysis, DNA

HIV encephalopathy usually presents with progressive dementia. However the spectrum of neurological manifestations of HIV infection is wide. A 46-year-old man presented with gait disturbance and dysarthria. He was given a neurological examination, which indicated dysarthria, cerebellar ataxia, and pyramidal tract signs. The patient's cognitive functions were intact. On serological study, HIV test was positive. Brain MRI and CSF analyses showed no evidence of tumor or other CNS infection. The patient was treated with highly active anti-retroviral therapy. Three months after treatment, cerebellar ataxia was much improved.
AIDS Dementia Complex ; Brain ; Cerebellar Ataxia* ; Dementia ; Dysarthria ; Gait ; HIV Infections* ; HIV* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Pyramidal Tracts

Immunological mechanisms involving the release of inflammatory factors by HIV-1 infected microglia in the brain have been implicated in the pathogenesis of HIV dementia (HIVD). Since the regulation of matrix metalloproteinases (MMPs) activity can be influenced by variety of inflammatory mediators, this study was undertaken to look for a correlation between the MMP-9 release and the production of TNF-alpha in response to HIV-1 p24 in the human monocyte cell line THP-1 as a model for microglia. First, it was shown that HIV-1 core p24 antigen induced THP-1 to secrete MMP-9 in a dose response manner while it elicited a little effect on MMP-2 release in human astroglial cell line T98G. Next, it was found that p24 induced THP-1 to secrete TNF-alpha without prior differentiation into macrophages by phorbol myristate acetate (PMA) treatment. Furthermore, anti-TNF-alpha neutralizing antibodies significantly blocked p24-induced MMP-9 release in a dose dependent manner. Our data indicate that p24 antigen induces monocytic MMP-9 release by triggering up-regulation of TNF-alpha secretion.
AIDS Dementia Complex ; Antibodies, Neutralizing ; Brain ; Cell Line* ; HIV-1* ; Humans* ; Macrophages ; Matrix Metalloproteinase 9* ; Matrix Metalloproteinases ; Microglia ; Monocytes ; Tetradecanoylphorbol Acetate ; Tumor Necrosis Factor-alpha* ; Up-Regulation

INTRODUCTIONHIV-associated neurocognitive disorders (HAND) comprise a wide spectrum of cognitive, motor, and mood abnormalities prevalent in people living with HIV and AIDS (PLWHAs). This field of HIV medicine has gained renewed prominence in recent years with evidence contending that anti-retroviral agents with increased central nervous system (CNS) penetration may improve neurocognitive outcomes in those affected. This review aims at evaluating the available evidence and postulating further study direction in Singapore.

MATERIALS AND METHODSA PubMed search was carried out for original articles and systematic reviews on the subject of HIV-associated neurocognitive disorders, and the results reviewed by the authors.

RESULTSThere is a growing body of evidence that HAND is not uncommon, and the advent of highly active anti-retroviral therapy has increased its prevalence by improving the prognosis of HIV infection, and hence increasing the likelihood of diagnosing of this neurocognitive condition. Screening and diagnosing HAND is important, and requires clinical suspicion as well as validated test batteries for optimal accuracy. The authors recommend strategies for detection in the local context involving stepwise targeted screening. Anti-retroviral agents with good CNS penetration and activity, as well as adjunctive neuro-rehabilitative interventions, may improve the impairments experienced by affected individuals.

CONCLUSIONIncreased awareness of HAND, with earlier diagnosis and targeted, multi-disciplinary management of this challenging condition, may lead to better all-round outcomes for people living with HIV and AIDS in Singapore.

AIDS Dementia Complex ; Anti-HIV Agents ; therapeutic use ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; HIV Infections ; drug therapy ; Humans ; Neurocognitive Disorders ; Prevalence

OBJECTIVETo study the genetic diversity of HIV-1 nef genes from a patient with AIDS dementia complex(ADC) , so as to research the amino acid variability and the pathogenesis of ADC.

METHODSThe nef gene was amplified with PCR from genomic DNA which was extracted from spleen and different brain tissues(basal ganglia, frontal gray matter, meninges, temporal lobe)of a patient who died of ADC. PCR products were cloned into the pMD19-T vector, after transformation and selection by ampicillin and blue/white spotting. Five of positive clones were sequenced and confirmed with BLAST. HIV-1 nef sequences were processed with BioEdit and MEGA4 to do Neighbor-Joining tree, p-Distances, and values of ds/dn.

RESULTSThe samples were all identified as HIV-1 B and genetic variation exists in HIV-1 nef gene isolated from different tissues compared with HXB2. In addition,part of the changes were different between periphery and brain.

CONCLUSIONVariations exist in the HIV-1 nef gene extracted from the ADC patient and the variations from peripheral and central nerve tissues were different,these variations may change the function of Nef,and it needs more research.

AIDS Dementia Complex ; virology ; Adult ; DNA, Viral ; genetics ; Genetic Variation ; HIV Infections ; virology ; HIV-1 ; genetics ; Humans ; Male ; nef Gene Products, Human Immunodeficiency Virus ; genetics

OBJECTIVETo study the diversity of HIV-1 tat gene in CNS and peripheral tissue of a patient with ADC and a patient with non-ADC, so as to research HIV evolution, the mechanism of CNS invasion and the pathogenesis of ADC.

METHODSThe tat gene was amplified with nested PCR from genomic DNA which was extracted from spleen and basal ganglia of one non-ADC patient with a wide range of cerebral artery atherosclerosis and one ADC patient. PCR products were cloned into the PGEM-T vector, after transformation and selection by ampicillin and blue/white spotting. Five of positive clones were sequenced. HIV-1 tat sequences were processed with BioEdit and MEGA4. With the softwares, neighbor-joining tree, p-distances, values of ds/dn, and analysis of amino acid motifs were all done, so as to research the diversity of HIV-1 tat gene in CNS and peripheral tissue.

RESULTSGene mutation of HIV-1 tat exist in the two patients, the mutation process of tat isolated from ADC patient suffered more compartmentalization than tat isolated from non-ADC patient, the differences of tat genes between CNS and peripheral tissue in ADC patient were greater than the non-ADC patient. Ds/dn showed that the virus gene mutation played a major role, the body intend to remove harmful non-synonymous mutations.

CONCLUSIONSThe compartmentation of tat gene in CNS and peripheral tissue of the two patients was different, the reason may be related to the pathway of HIV into the CNS, the relationship between HIV gene mutation in CNS and ADC still need more investigation.

AIDS Dementia Complex ; virology ; Adult ; Amino Acid Sequence ; Central Nervous System ; virology ; Female ; Genetic Variation ; HIV-1 ; genetics ; isolation & purification ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Peripheral Nervous System ; virology ; tat Gene Products, Human Immunodeficiency Virus ; genetics

To explore the relationship between the genetic diversity and biological functional site of human immunodeficiency virus HIV-1 gp120 and the pathogenesis of AIDS dementia complex (ADC), the full length sequences of gp120 gene was amplified with PCR from genomic DNA which was extracted from lymphoid and different brain department (periaortic lymphoid, temporal gray/white matter junction, periventricular tissue, choroids plexus, occipital white matter and occipital gray/white matter junction.) of a patient who died of ADC. PCR products were cloned into the pGEM-T vector and positive clones were sequenced. The analysis of neighbor-joining tree, N-glycosylation sites, values of ds/dn, and loop were then all performed. The samples were all identified as HIV-1 B and genetic variation existed in HIV-1 gp120 isolated from different tissues. Compared with standard HIV-1B gp120, biological functional sites of HIV-1 gp120 isolated from the patient changed to some extent. In addition, there were differences in some biological functional sites of HIV-1 gp120 between lymphoid and brain. Therefore, genetic diversity and alterations of some biological functional sites of HIV-1 gp120 might be associated with the pathogenesis of ADC.
AIDS Dementia Complex ; virology ; Amino Acid Sequence ; Genetic Variation ; genetics ; HIV Envelope Protein gp120 ; chemistry ; classification ; genetics ; Humans ; Molecular Sequence Data ; Phylogeny ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Sequence Homology, Amino Acid