DSM-IV

In DSM-IV, this disorder is called Dementia Due to HIV Disease

For more information, see Dementia Due to Other General Medical Conditions

The essential feature of Dementia Due to HIV Disease is the presence of a dementia that is judged to be the direct pathophysiological consequence of human immunodeficiency virus (HIV) disease. Neuropathological findings most commonly involve diffuse, multifocal destruction of the white matter and subcortical structures. The spinal fluid may show normal or slightly elevated protein and a mild lymphocytosis, and HIV can usually be isolated directly from cerebrospinal fluid. Dementia that is associated with direct HIV infection of the central nervous system is typically characterized by forgetfulness, slowness, poor concentration, and difficulties with problem solving. Behavioral manifestations most commonly include apathy and social withdrawal, and occasionally these may be accompanied by delirium, delusions, or hallucinations. Tremor, impaired rapid repetitive movements, imbalance, ataxia, hypertonia, generalized hyperreflexia, positive frontal release signs, and impaired pursuit and saccadic eye movements may be present on physical examination. Children may also develop Dementia Due to HIV Disease, typically manifested by developmental delay, hypertonia, microcephaly, and basal ganglia calcification. Dementia in association with HIV infection may also result from accompanying central nervous system tumors (e.g., primary central nervous system lymphoma) and from opportunistic infections (e.g., toxoplasmosis, cytomegalovirus infection, cryptococcosis, tuberculosis, and syphilis), in which case the appropriate type of dementia should be diagnosed (e.g., Dementia Due to Toxoplasmosis). Unusual systemic infections (e.g., Pneumocystis carinii pneumonia) or neoplasms (e.g., Kaposi's sarcoma) may also be present.

DSM-5

For more information, see Major and Mild Neurocognitive Disorders

Diagnostic Criteria

A. The criteria are met for major or mild neurocognitive disorder.

B. There is documented infection with human immunodeficiency virus (HIV).

C. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.

D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Differential Diagnosis

In the presence of comorbidities, such as other infections (e.g., hepatitis C virus, syphilis), drug abuse (e.g., methamphetamine abuse), or prior head injury or neurodevelopmental conditions, major or mild NCD due to HIV infection can be diagnosed provided there is evidence that infection with HIV has worsened any NCDs due to such preexsting or comorbid conditions. Among older adults, onset of neurocognitive decline related to cerebrovascular disease or neurodegeneration (e.g., major or mild NCD due to Alzheimer's disease) may need to be differentiated. In general, stable, fluctuating (without progression) or improving neurocognitive status would favor an HIV etiology, whereas steady or stepwise deterioration would suggest neurodegenerative or vascular etiology. Because more severe immunodeficiency can result in opportunities infections of the brain (e.g., toxoplasmosis; cryptococcosis) and neoplasia (e.g., CNS lymphoma), sudden onset of an NCD or sudden worsening of that disorder demands active investigation of non-HIV etiologies.

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