Alzheimer's disease neuropathology may not predict functional impairment in HIV: a report of two individuals.

TitleAlzheimer's disease neuropathology may not predict functional impairment in HIV: a report of two individuals.
Publication TypeJournal Article
Year of Publication2018
AuthorsMorgello, S, Jacobs, M, Murray, J, Byrd, D, Neibart, E, Mintz, L, Meloni, G, Chon, C, Crary, J
JournalJ Neurovirol
Date Published2018 10
KeywordsAged, 80 and over, AIDS Dementia Complex, Alzheimer Disease, Autopsy, Brain, Female, Humans, Middle Aged

With aging of HIV populations, there is concern that Alzheimer's disease (AD) may become prevalent and difficult to distinguish from HIV-associated neurocognitive disorders. To date, there are no reports documenting histologically verified Alzheimer's neuropathology in individuals with HIV and dementia. Herein, we report two antiretroviral-treated, virally suppressed, HIV-infected individuals autopsied by the Manhattan HIV Brain Bank. Subject A presented to study at 52 years, already dependent in instrumental activities of daily living (ADLs), with severe cognitive impairment inclusive of learning and memory dysfunction. Her history was significant for educational disability and head trauma. She had rapid cognitive decline and, by death at age 59 years, was bed-bound, incontinent, and non-communicative. At autopsy, she exhibited severe AD neuropathologic change (NIA-AA score A3B3C3) and age-related tau astrogliopathy (ARTAG). She was homozygous for APOE ε3/ε3. No HIV DNA was detected in frontal lobe by nested polymerase chain reaction. Subject B was a community dwelling 81-year-old woman who experienced sudden death by pulmonary embolus. Prior to death, she was fully functional, living independently, and managing all ADLs. At autopsy, she displayed moderate amyloid and severe tau AD neuropathologic changes (A2B3C2), ARTAG, and cerebral congophilic angiopathy. She was an APOE ε3/ε4 heterozygote, and HIV DNA, but not RNA, was detected in frontal lobe, despite 20 years of therapy-induced viral suppression. We conclude that in the setting of HIV, AD neuropathology may occur with or without symptomatic cognitive dysfunction; as with seronegative individuals, there are likely to be complex factors in the generation of clinically relevant impairments.

Alternate JournalJ Neurovirol
PubMed ID30094630
PubMed Central IDPMC6202220
Grant ListR24 MH059724 / MH / NIMH NIH HHS / United States
K01 DA035725 / DA / NIDA NIH HHS / United States
U24 MH100931 / MH / NIMH NIH HHS / United States
K01DA035725 / DA / NIDA NIH HHS / United States
UL1 TR001433 / TR / NCATS NIH HHS / United States
R01 NS095252 / NS / NINDS NIH HHS / United States
UL1TR001433 / NH / NIH HHS / United States
R01NS095252 / NS / NINDS NIH HHS / United States
U24MH100931 / MH / NIMH NIH HHS / United States
R01 AG054008 / AG / NIA NIH HHS / United States