A 68-year-old man who was a diagnosed case of HIV infection for last 12 years was brought to outpatient depament for evaluation. His wife repos that for last 6 months she has been noticing changes in his behaviour. She fuher added that ‘He appears uninterested and doesn’t seem to care about anything. I haven’t seen him crying or saying something negative, but may be he is getting depressed. He is also having difficulty remembering things ‘ The patient has been irregular with his HIV medications. His last CD4+ cell count, measured 5 months ago, was 210/mm3. While walking , patient was observed to have subtle jerking movements. Which of the following is the likely diagnosis?
A 68-year-old man who was a diagnosed case of HIV infection for last 12 years was brought to outpatient depament for evaluation. His wife repos that for last 6 months she has been noticing changes in his behaviour. She fuher added that ‘He appears uninterested and doesn’t seem to care about anything. I haven’t seen him crying or saying something negative, but may be he is getting depressed. He is also having difficulty remembering things ‘ The patient has been irregular with his HIV medications. His last CD4+ cell count, measured 5 months ago, was 210/mm3. While walking , patient was observed to have subtle jerking movements. Which of the following is the likely diagnosis?
💡 Explanation
**Core Concept**
The question is testing the student's knowledge of the neurological manifestations of HIV infection, particularly in the context of antiretroviral therapy (ART) non-adherence and immune reconstitution. **HIV-associated neurocognitive disorder (HAND)** encompasses a spectrum of cognitive, motor, and behavioral symptoms that arise from HIV infection and its treatment.
**Why the Correct Answer is Right**
The patient's symptoms, including apathy, difficulty with memory, and subtle jerking movements, are characteristic of **HIV-associated neurocognitive disorder (HAND)**, specifically the HAND subtype known as **HIV-associated minor cognitive-motor disorder (MCD)**. The patient's history of irregular HIV medication adherence and low CD4+ cell count suggest a compromised immune system, making him susceptible to HAND. The jerking movements are likely due to **HIV-associated chorea**, a rare but serious complication of HIV infection.
**Why Each Wrong Option is Incorrect**
**Option A:** **HIV-associated dementia (HAD)** is a more severe form of HAND, typically presenting with significant cognitive impairment, motor dysfunction, and behavioral changes. The patient's symptoms do not meet the criteria for HAD.
**Option B:** **Progressive multifocal leukoencephalopathy (PML)** is a rare and often fatal demyelinating disease caused by JC virus reactivation in immunocompromised patients. While PML can present with cognitive and motor symptoms, it is not the most likely diagnosis in this case.
**Option C:** **Toxicity from antiretroviral therapy (ART)** is a possibility in patients with irregular medication adherence. However, the patient's symptoms are more suggestive of a direct effect of HIV infection rather than ART toxicity.
**Option D:** **Depression** is a common comorbidity in patients with HIV infection, but the patient's symptoms, particularly the subtle jerking movements, are not typical of depression alone.
**Clinical Pearl / High-Yield Fact**
In patients with HIV infection, HAND can occur at any stage of the disease, even in those with well-controlled viral loads and high CD4+ cell counts. Irregular ART adherence and low CD4+ cell counts increase the risk of HAND.
**Correct Answer:** C. HIV-associated minor cognitive-motor disorder (MCD).
✓ Correct Answer: C. HIV-associated dementia
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