Calcagno Andrea, Celani Luigi, Trunfio Mattia, Orofino Giancarlo, Imperiale Daniele, Atzori Cristiana, Arena Vincenzo, d'Ettorre Gabriella, Guaraldi Giovanni, Gisslen Magnus, Di Perri Giovanni
Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden.
Neurol Clin Pract. 2021 Oct;11(5):e627-e633. doi: 10.1212/CPJ.0000000000001060.
Given the aging of people living with HIV (PLWH) and the high prevalence of HIV-associated neurocognitive disorders, we aimed at describing the clinical, instrumental, and CSF features of PLWH diagnosed with Alzheimer dementia (AD).
The databases of 3 large Italian outpatient clinics taking care of more than 9,000 PLWH were searched for the diagnosis of AD. After obtaining patients' or their next of kin's consent for publication, anonymous data were collected in an excel spreadsheet and described. Routinely collected CSF biomarkers and radiologic imaging results were recorded whether available.
Four patients were included in this case series who were diagnosed with AD aged between 60 and 74 years. All participants were on highly active antiretroviral therapy and showed nondetectable serum HIV RNA. Memory impairment was the most prominent cognitive feature. The diagnosis was obtained considering the exclusion of other potential causes, MRI and fluorodeoxyglucose-PET features, and, in (in 2/4), CSF AD biomarkers levels. In 1 patient, longitudinal CSF tau/p-tau increased, and beta-amyloid decreased over time despite antiretroviral therapy containing nucleotide reverse transcriptase inhibitors.
In older PLWH cognitive symptoms may represent the onset of AD: a multidisciplinary team may be needed for reaching a likely in vivo diagnosis.
鉴于艾滋病毒感染者（PLWH）的老龄化以及艾滋病毒相关神经认知障碍的高患病率，我们旨在描述被诊断为阿尔茨海默病（AD）的PLWH的临床、仪器检查和脑脊液特征。
在3家为9000多名PLWH提供治疗的大型意大利门诊诊所的数据库中搜索AD诊断信息。在获得患者或其近亲的出版同意后，将匿名数据收集到一个Excel电子表格中并进行描述。记录常规收集的脑脊液生物标志物和放射影像学结果（如可获得）。
该病例系列纳入了4名被诊断为AD的患者，年龄在60至74岁之间。所有参与者均接受高效抗逆转录病毒治疗，血清HIV RNA检测不到。记忆障碍是最突出的认知特征。通过排除其他潜在病因、MRI和氟脱氧葡萄糖-PET特征以及（2/4的患者）脑脊液AD生物标志物水平来做出诊断。在1例患者中，尽管接受了含核苷酸逆转录酶抑制剂的抗逆转录病毒治疗，但随着时间推移，脑脊液tau/p-tau升高，β-淀粉样蛋白降低。
在老年PLWH中，认知症状可能代表AD的发病：可能需要一个多学科团队来做出可能的体内诊断。
