HIV認知症、((旧))HIV痴呆

関: AIDS dementia complex、AIDS encephalopathy、AIDS-related dementia complex、HIV encephalopathy

WordNet

the 8th letter of the Roman alphabet (同)h
mental deterioration of organic or functional origin (同)dementedness
infection by the human immunodeficiency virus

PrepTutorEJDIC

hydrogenの化学記号
鉛筆の硬度 / 《俗》heroin
(医学的な)痴呆(ちほう)
Hawaii

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/11/06 11:06:54」(JST)

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[Wiki en表示]

HIV-associated neurocognitive disorders (HAND) are neurological disorders associated with HIV infection and AIDS. HAND may include neurological disorders of various severity such as AIDS dementia complex (ADC) also known as HIV dementia and HIV-associated dementia (HAD), HIV encephalopathy, and Mild Neurocognitive Disorder (MND). HIV-associated neurocognitive disorders are associated with a metabolic encephalopathy induced by HIV infection and fueled by immune activation of macrophages and microglia.^[1] These cells are actively infected with HIV and secrete neurotoxins of both host and viral origin. The essential features of ADC are disabling cognitive impairment accompanied by motor dysfunction, speech problems and behavioral change. Cognitive impairment is characterised by mental slowness, trouble with memory and poor concentration. Motor symptoms include a loss of fine motor control leading to clumsiness, poor balance and tremors. Behavioral changes may include apathy, lethargy and diminished emotional responses and spontaneity. Histopathologically, it is identified by the infiltration of monocytes and macrophages into the central nervous system (CNS), gliosis, pallor of myelin sheaths, abnormalities of dendritic processes and neuronal loss.^[1]^[2]

ADC typically occurs after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. It is sometimes seen as the first sign of the onset of AIDS. Prevalence is between 10-24% in Western countries^[3] and has only been seen in 1-2% of India-based infections.^[4]^[5] With the advent of highly active antiretroviral therapy (HAART), the incidence of ADC has declined in developed countries, although its prevalence is increasing.^[6]^[7] HAART may prevent or delay the onset of ADC in people with HIV infection, and may also improve mental function in people who already have ADC.

Dementia only exists when neurocognitive impairment in the patient is severe enough to interfere markedly with day-to-day function. That is, the patient is typically unable to work and may not be able to take care of him or herself. Before this, the patient is said to have a mild neurocognitive disorder.

Diagnostic criteria

Marked acquired impairment of at least two ability domains of cognitive function (e.g. memory, attention): typically, the impairment is in multiple domains, especially in learning, information processing and concentration/attention. The cognitive impairment is ascertained by medical history, mental status examination or neuropsychological testing.
Cognitive impairments identified in 1 interfere markedly with day-to-day functioning.
Cognitive impairments identified in 1 are present for at least one month.
Cognitive impairments identified in 1 do not meet the criteria for delirium, or if delirium is present, dementia was diagnosed when delirium was not present.
No evidence of another, pre-existing aetiology that could explain the dementia (e.g. another CNS infection, CNS neoplasm, cerebrovascular disease, pre-existing neurological disease, severe substance abuse compatible with CNS disorder.^[8]

While the progression of dysfunction is variable, it is regarded as a serious complication and untreated can progress to a fatal outcome. Diagnosis is made by neurologists who carefully rule out alternative diagnoses. This routinely requires a careful neurological examination, brain scans (MRI or CT scan) and a lumbar puncture to evaluate the cerebrospinal fluid. No single test is available to confirm the diagnosis, but the constellation of history, laboratory findings and examination can reliably establish the diagnosis when performed by experienced clinicians. The amount of virus in the brain does not correlate well with the degree of dementia, suggesting that secondary mechanisms are also important in the manifestation of ADC.

Research

AIDS Dementia Complex (ADC) is not a true opportunistic infection; it is one of the few conditions caused directly by HIV itself. However, the etiology of ADC can be difficult to discern because the central nervous system can be damaged by a number of other causes related to HIV infection:

opportunistic infections
Primary cerebral lymphoma or metastasis of other AIDS-related cancers
direct effects of HIV in the brain
toxic effects of drug treatments
malnutrition

Many researchers believe that HIV damages the vital brain cells, neurons, indirectly. According to one theory, HIV either infects or activates cells that nurture and maintain the brain, known as macrophages and microglia. These cells then produce toxins that can set off a series of reactions that instruct neurons to kill themselves. The infected macrophages and microglia also appear to produce additional factors such as chemokines and cytokines that can affect neurons as well as other brain cells known as astrocytes. The affected astrocytes, which normally nurture and protect neurons, also may now end up harming neurons. HIV protein gp120 inhibits the stem cells in the brain from producing new nerve cells.^[9] In the neuronal cells, the HIV gp120 induces mitochondrial-death proteins like caspases, which may influence the upregulation of the death receptor Fas leading to apoptosis.^[10] Researchers hope that new drugs under investigation will interfere with the detrimental cycle and prevent neuron death.

ADC stage characteristics

Stage 0 (Normal) Normal Mental and Motor Function
Stage 0.5 (Subclinical) Minimal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs (snout response, slowed extremity movements), but without impairment of work or capacity to perform activities of daily living (ADL). Gait and strength are normal.
Stage 1 (Mild) Evidence of functional intellectual or motor impairment characteristic of ADC, but able to perform all but the more demanding aspects of work or ADL. Can walk without assistance.
Stage 2 (Moderate) Cannot work or maintain the more demanding aspects of daily life, but able to perform basic activities of self care. Ambulatory, but may require a single prop.
Stage 3 (Severe) Major intellectual incapacity - cannot follow news or personal events, cannot sustain complex conversation, considerable slowing of all output. And/or motor disability - cannot walk unassisted, requiring walker or personal support, usually with slowing and clumsiness of arms as well.
Stage 4 (End Stage) Nearly vegetative. Intellectual and social comprehension and responses are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with urinary incontinence and fecal incontinence.

References

^ ^a ^b Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C. (2001). "Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments". Clin. Neuropathol. 20 (4): 146–55. PMID 11495003.
^ Adle-Biassette, H., Lévy, Y., Colombel, M., Poron, F., Natchev, S., Keohane, C. and Gray, F. (1995). "Neuronal apoptosis in HIV infection in adults". Neuropathol. Appl. Neurobiol. 21 (3): 218–27. doi:10.1111/j.1365-2990.1995.tb01053.x. PMID 7477730.
^ Grant, I., Sacktor, H., and McArthur, J. (2005). "HIV neurocognitive disorders" (PDF). In H. E. Gendelman; I. Grant; I. Everall; S. A. Lipton; S. Swindells. The Neurology of AIDS (2nd ed.). London, UK: Oxford University Press. pp. 357–373. ISBN 0-19-852610-5.
^ Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K. (2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96)". Indian J. Med. Res. 111: 14–23. PMID 10793489.
^ Wadia, R. S., Pujari, S. N., Kothari, S., Udhar, M., Kulkarni, S., Bhagat, S., and Nanivadekar, A. (2001). "Neurological manifestations of HIV disease". J. Assoc. Physicians India. 49: 343–8. PMID 11291974.
^ Ellis, R., Langford, D., and Masliah, E. (2007). "HIV and antiretroviral therapy in the brain: neuronal injury and repair". Nat. Rev. Neurosci. 8 (1): 33–44. doi:10.1038/nrn2040. PMID 17180161.
^ Gonzalez-Scarano, F.; Martin-Garcia, J. (2005). "The neuropathogenesis of AIDS". Nat. Rev. Immunol. 5 (1): 69–81. doi:10.1038/nri1527. PMID 15630430.
^ Grant, I., Atkinson, J. (1995). "Psychiatric aspects of acquired immune deficiency syndrome." (PDF). In Kaplan, H.I. and Sadock, B.J. Comprehensive textbook of psychiatry. 2 (6th ed.). Baltimore, MD: Williams and Wilkins. pp. 1644–1669. ISBN 0-683-04532-6.
^ Okamoto, Shu-ichi; Y. Kang; C.W. Brechtel; E. Siviglia; R. Russo; A. Clemente; A. Harrop; S. McKercher; M. Kaul; S.A. Lipton (2007). "HIV/gp120 decreases adult neural progenitor cell proliferation via checkpoint kinase-mediated cell-cycle withdrawal and G1 arrest". Cell Stem Cell. 1 (2): 230–6. doi:10.1016/j.stem.2007.07.010. PMID 18371353.
^ Thomas, S; Mayer, L; Sperber, K (2009). "Mitochondria influence Fas expression in gp120-induced apoptosis of neuronal cells". The International journal of neuroscience. 119 (2): 157–65. doi:10.1080/00207450802335537. PMID 19125371.

UpToDate Contents

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1. HIV感染関連の認知機能障害 hiv associated neurocognitive disorders
2. HIV感染およびAIDSの神経精神学的側面の概要 overview of the neuropsychiatric aspects of hiv infection and aids
3. Early-onset dementia in adults
4. HIV感染患者における抗レトロウイルス療法の開始時期 when to initiate antiretroviral therapy in hiv infected patients
5. HIV感染患者におけるうつ病、躁病、および統合失調症 depression mania and schizophrenia in hiv infected patients

English Journal

MiR-133b-5p regulates the expression of the heat shock protein 70 during rat neuronal cell apoptosis induced by the gp120 V3 loop peptide.

Xia C1, Cai Y2, Lin Y1,3, Guan R1,3, Yang J1,3, Xiao G1,3.
Journal of medical virology.J Med Virol.2015 Aug 17. doi: 10.1002/jmv.24355. [Epub ahead of print]
BACKGROUND: Neuronal cell dysfunction and apoptosis, the main causes of HIV-associated dementia, and its underlying mechanism are important unsolved health problems. Many research reports suggest that miRNAs regulate HIV-1-induced apoptosis.METHODS: We used the HIV-1 gp120 V3 Loop peptide to induce
PMID 26280272

Targeted SLNs for management of HIV-1 associated dementia.

Rai A1, Jain A, Jain A, Jain A, Pandey V, Chashoo G, Soni V, Sharma PR.
Drug development and industrial pharmacy.Drug Dev Ind Pharm.2015 Aug;41(8):1321-7. doi: 10.3109/03639045.2014.948453. Epub 2014 Aug 12.
CONTEXT: HIV-1 associated dementia (HAD) is an evolving disease in the category of neurological disorders.OBJECTIVE: Nifedipine-loaded solid lipid nanoparticles (SLNs) were developed and coated with Tween 80 to facilitate enhanced brain drug delivery for the treatment of HAD.MATERIALS AND METHODS: S
PMID 25113430

Virologically suppressed patients with asymptomatic and symptomatic HIV-associated neurocognitive disorders do not display the same pattern of immune activation.

Vassallo M1,2, Durant J1, Lebrun-Frenay C3, Fabre R4, Ticchioni M5, Andersen S1, DeSalvador F1, Harvey-Langton A1, Dunais B1,4, Cohen-Codar I6, Montagne N2, Cua E1,2, Fredouille-Heripret L2, Laffon M3, Cottalorda J7, Dellamonica P1, Pradier C4.
HIV medicine.HIV Med.2015 Aug;16(7):431-40. doi: 10.1111/hiv.12246. Epub 2015 May 18.
OBJECTIVES: Inversion of the CD4:CD8 ratio is a marker of immune activation and age-associated disease. We measured the CD4:CD8 ratio as a marker of cognitive impairment in HIV-infected patients and explored differences according to clinical severity.METHODS: Post hoc analysis of data from two prosp
PMID 25981452

Japanese Journal

症例報告 cART開始2年後に薬剤耐性化によるHIV脳症をきたした1例

関谷博顕,川本未知,十河正弥 [他]
臨床神経学 = Clinical neurology 54(9), 721-725, 2014-09
NAID 40020196301

HIV関連神経認知障害が疑われたHIV感染者の検討

森岡悠,岸田修二,今村顕史 [他]
感染症学雑誌 = The journal of Japanese the Association for Infectious Diseases 88(2), 141-148, 2014-03
NAID 40020055900

神経心理検査で改善が示唆されたHIV-associated dementiaの1例

森岡悠,今村顕史
HIV
NAID 40020122241

「AIDS-related dementia complex」

AIDS dementia complex
Classification and external resources
Specialty	psychiatry
ICD-10	B22, F02.4
ICD-9-CM	042
MeSH	D015526
	[edit on Wikidata]

　　[★]

エイズ関連認知症症候群、AIDS関連認知症症候群

関: AIDS dementia complex、AIDS encephalopathy、HIV dementia、HIV encephalopathy

「HIV痴呆」

　　[★]

英: HIV dementia
関: エイズ痴呆症、HIV脳症、エイズ脳症、HIV認知症、エイズ関連認知症症候群

「HIV encephalopathy」

　　[★]

HIV脳症

関: AIDS dementia complex、AIDS encephalopathy、AIDS-related dementia complex、HIV dementia

「HIV認知症」

　　[★]

英: HIV dementia
関: HIV痴呆

「dement」

　　[★]

v.

痴呆になる、発狂する

関: dementia、dementing、deterioration

「HIV」

　　[★] human immunodeficiency virus HIVウイルスヒト免疫不全ウイルス　

「H」

　　[★]

「HI」

　　[★] 赤血球凝集抑制試験　

[Gray-1] Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C. (2001). "Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments". Clin. Neuropathol. 20 (4): 146–55. PMID 11495003.

[Adle-2] Adle-Biassette, H., Lévy, Y., Colombel, M., Poron, F., Natchev, S., Keohane, C. and Gray, F. (1995). "Neuronal apoptosis in HIV infection in adults". Neuropathol. Appl. Neurobiol. 21 (3): 218–27. doi:10.1111/j.1365-2990.1995.tb01053.x. PMID 7477730.

[Grant-3] Grant, I., Sacktor, H., and McArthur, J. (2005). "HIV neurocognitive disorders" (PDF). In H. E. Gendelman; I. Grant; I. Everall; S. A. Lipton; S. Swindells. The Neurology of AIDS (2nd ed.). London, UK: Oxford University Press. pp. 357–373. ISBN 0-19-852610-5.

[Satischandra-4] Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K. (2000). "Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96)". Indian J. Med. Res. 111: 14–23. PMID 10793489.

[Wadia-5] Wadia, R. S., Pujari, S. N., Kothari, S., Udhar, M., Kulkarni, S., Bhagat, S., and Nanivadekar, A. (2001). "Neurological manifestations of HIV disease". J. Assoc. Physicians India. 49: 343–8. PMID 11291974.

[6] Ellis, R., Langford, D., and Masliah, E. (2007). "HIV and antiretroviral therapy in the brain: neuronal injury and repair". Nat. Rev. Neurosci. 8 (1): 33–44. doi:10.1038/nrn2040. PMID 17180161.

[7] Gonzalez-Scarano, F.; Martin-Garcia, J. (2005). "The neuropathogenesis of AIDS". Nat. Rev. Immunol. 5 (1): 69–81. doi:10.1038/nri1527. PMID 15630430.

[Atkinson-8] Grant, I., Atkinson, J. (1995). "Psychiatric aspects of acquired immune deficiency syndrome." (PDF). In Kaplan, H.I. and Sadock, B.J. Comprehensive textbook of psychiatry. 2 (6th ed.). Baltimore, MD: Williams and Wilkins. pp. 1644–1669. ISBN 0-683-04532-6.

[9] Okamoto, Shu-ichi; Y. Kang; C.W. Brechtel; E. Siviglia; R. Russo; A. Clemente; A. Harrop; S. McKercher; M. Kaul; S.A. Lipton (2007). "HIV/gp120 decreases adult neural progenitor cell proliferation via checkpoint kinase-mediated cell-cycle withdrawal and G1 arrest". Cell Stem Cell. 1 (2): 230–6. doi:10.1016/j.stem.2007.07.010. PMID 18371353.

[10] Thomas, S; Mayer, L; Sperber, K (2009). "Mitochondria influence Fas expression in gp120-induced apoptosis of neuronal cells". The International journal of neuroscience. 119 (2): 157–65. doi:10.1080/00207450802335537. PMID 19125371.

リンク元	「AIDS-related dementia complex」「HIV痴呆」「HIV encephalopathy」「HIV認知症」
関連記事	「dement」「HIV」「H」「HI」

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HIV dementia