Journal of NeuroVirology

, Volume 7, Issue 1, pp 66–71 | Cite as

Acceleration of HIV dementia with methamphetamine and cocaine

  • Avindra Nath
  • William F. Maragos
  • Malcolm J. Avison
  • Frederick A. Schmitt
  • Joseph R. Berger
Case Report


We report a patient with rapidly accelerating HIV dementia accompanied by seizures and an unusual movement disorder despite highly potent antiretroviral therapy. This clinical constellation was associated with the non-parenteral use of methamphetamine and cocaine. Fractional enhancement time on post contrast magnetic resonance imaging studies revealed a progressive breakdown of the blood brain barrier particularly in the basal ganglia. The movement disorder but not the dementia responded to a combination of dopamine replacement and anticholinergic therapy. While the movement disorder may have been unmasked by concomitant anticonvulsant therapy, we suggestin this instance, that prior drug abuse synergized with HIV to cause a domino effect on cerebral function. Careful attention and analysis to histories of remote non-injecting drug abuse may help substantiate our hypothesis.


HIV brain AIDS cocaine methamphetamine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aweeka F, Jayewardene A, Staprans S, Bellibas SE, Kearney B, Lizak P, Novakovic-Agopian T, Price RW (1999). Failure to detect nelfinavir in the cerebrospinal fluid of HIV-1-infected patients with and without AIDS dementia complex. J Acquir Immune Defic Syndr Hum Retrovirol 20: 39–43.PubMedGoogle Scholar
  2. Bell JE, Brettle RP, Chiswick A, Simmonds P (1998). HIV encephalitis, proviral load and dementia in drug users and homosexuals with AIES. Effect of neocortical involvement. Brain 121: 2043–2052.CrossRefPubMedGoogle Scholar
  3. Berger JR, Kumar M, Kumar A, Fernandez JB, Levin B (1994). Cerebrospinal fluid dopamine in HIV-l infection. AIDS 8: 67–71.CrossRefPubMedGoogle Scholar
  4. Berger JR, Nath A (1997). HIV dementia and the basal ganglia. Intervirology 40: 122–131.CrossRefPubMedGoogle Scholar
  5. Berger JR, Nath A, Greenberg RN, Andersen AH, Greene RA, Bognar A, Avison MJ (2000). Cerebrovascular changes in the basal ganglia with HIV dementia. Neurology 54: 921–926.PubMedGoogle Scholar
  6. Bouwman FH, Skolasky RL, Hes D, Scines OA, Glass JD, Nance-Sproson TE, Royal W, Dal Pan GJ, McArthur JC (1998). Variable progression of HIV-associated dementia. Neurology 50: 1814–1820.PubMedGoogle Scholar
  7. Concha M, Graham NM, Munoz A, Vlahov D, Royal WD, Updike M, Nance-Sproson T, Scines OA, McArthur JC (1992). Effect of chronic substance abuse on the neuropyschological performance of intravenous drug users with a high prevalence of HIV-l seropositivity. Am J Epidemiol 136: 1338–1348.PubMedGoogle Scholar
  8. Concha M, Scines OA, Vlahov D, Nance-Sproson T, Updike M, Royal W, Palenicek J, McArthur JC (1997). Comparison of neuropsychological performance between AIDS-free injecting drug users and homosexual men. Neuroepidemiology 16: 78–85.CrossRefPubMedGoogle Scholar
  9. Ernst T, Chang L, Leonido-Yee M, Speck O (2000). Evidence of long term neurotoxicity associated with methamphetamine abuse. A 1H MRS study. Neurology 54: 1344–1349.PubMedGoogle Scholar
  10. Fiala M, Gan XH, Zhang L, House SD, Newton T, Graves MC, Shapshak P, Stins M, Kim KS, Witte M, Chang SL (1998). Cocaine enhances monocyte migration across the blood-brain barrier. Cocaine’s connection to AIDS dementia and vasculitis? Adv Exp Med Biol 437: 199–205.PubMedGoogle Scholar
  11. Fujimura RK, Goodkin K, Petito CK, Douyon R, Feaster DJ, Concha M, Shapshak P (1997). HIV-l proviral DNA load across neuroanatomic regions of individuals with evidence for HTV-1-associated dementia. J Acquir Immune Defic Syndr Hum Retrovirol 16: 146–152.PubMedGoogle Scholar
  12. Gendelman H, Zheng J, Coulter C, Ghorpade A, Che M, Thylin M, Rubocki R, Persidsky Y, Hahn F, Reinhard J, Swindells S (1998). The HIV-associated dementia complex: a metabolic encephalopathy reversed by highly active antiretroviral therapy. J Infect Dis 178: 1000–1007.CrossRefPubMedGoogle Scholar
  13. Grassi MP, Perin C, Clerici F, Zocchetti C, Borella M, Cargnel A, Mangoni A (1997). Effects of HIV seropositivity and drug abuse on cognitive function. Eur Neurol 37: 48–52.CrossRefPubMedGoogle Scholar
  14. Harrison MB, Lyons GR, Landow ER (1993). Phenytoin and dyskinesias: a report of two cases and review of the literature. Mov Disord 8: 19–27.CrossRefPubMedGoogle Scholar
  15. Hayman M, Arbuthnott G, Harkiss G, Brace H, Filippi P, Philippon V, Thomson D, Vigne R, Wright A (1993). Neurotoxicity of peptide analogues of the transactivating protein tat from Maedia-Visna virus and human immunodeficiency virus. Neuroscience 53: 1–6.CrossRefPubMedGoogle Scholar
  16. Hofman FM, Dohadwala MM, Wright AD, Hinton DR, Walker SM (1994). Exogenous tat protein activates central nervous system-derived endothelial cells. J Neuroimmunol 54: 19–28.CrossRefPubMedGoogle Scholar
  17. Jones M, Olafson K, Del Bigio MR, Peeling J, Nath A (1998). Intraventricular injection of human immunodeficiency virus type 1 (HTV-l) Tat protein causes inflammation, gliosis, apoptosis, and ventricular enlargement. J Neuropathol Exp Neurol 57: 563–570.CrossRefPubMedGoogle Scholar
  18. Kruman II, Nath A, Maragos WF, Chan SL, Jones M, Rangnekar VM, Jakel RJ, Mattson MP (1999). Evidence that Par-4 participates in the pathogenesis of AIDS dementia. Am J Pathol 155: 39–46.PubMedGoogle Scholar
  19. Langston JW, Forno LS, Tetrud J, Reeves AG, Kaplan JA, Karluk D (1999). Evidence of active nerve cell degeneration in the substantia nigra of humans years after l-methyl-4-phenyl-l,2,3,6-tetrahydropyridine exposure. Ann Neurol 46: 598–605.CrossRefPubMedGoogle Scholar
  20. Larsson M, Hagberg L, Foreman A, Norkrans G (1991). Cerebrospinal fluid catecholamine metabolites in hIV-infected patients. J Neurosci Res 28: 406–409.CrossRefPubMedGoogle Scholar
  21. Nath A, Conant K, Chen P, Scott C, Major EO (1999). Transient exposure to HIV-l Tat protein results in cytokine production in macrophages and astrocytes: A hit and run phenomenon. J Biol Chem 274: 17098–17102.CrossRefPubMedGoogle Scholar
  22. Nath A, Geiger JD (1998). Neurobiological aspects of HIV infections: neurotoxic mechanisms. Prog Neurobiol 54: 19–33.CrossRefPubMedGoogle Scholar
  23. Nath A, Haughey NJ, Jones M, Anderson C, Bell JE, Geiger JD (2000). Synergistic neurotoxicity by human immunodeficiency virus proteins Tat and gp120: protection by memantine. Ann Neurol 47: 186–194.CrossRefPubMedGoogle Scholar
  24. Nath A, Jones M, W, M, Booze RM, Mactutus C, Bell J, Mattson M (2000). Neurotoxicity and E)ysfunction of Eopaminergic Systems Associated with AIDS Dementia. J Psychopharmacology (in press).Google Scholar
  25. Navia BA, Cho ES, Petiio CK, Price RW (1986). The AIDS dementia complex: II Neuropathology. Ann Neurol 19, 525–535.CrossRefPubMedGoogle Scholar
  26. Power C, McArthur JC, Johnson RT, Griffin DE, Glass JD, Perryman S, Chesebro B (1994). Demented and nondemented patients with AIDS differ in brain-derived human immunodeficiency virus type 1 envelope sequences. J Virol 68: 4643–4649.PubMedGoogle Scholar
  27. Power C, Scines OA, Grim JA, McArthur JC (1995). HIV Dementia Scale: a rapid screening test. J Acquir Immune Defic Syndr Hum Retrovirol 8: 273–278.CrossRefPubMedGoogle Scholar
  28. Price RW, Brew BJ (1988). The AIDS dementia complex. J Infect Dis 158: 1079–1083.PubMedGoogle Scholar
  29. Price RW, Yiannoutsos CT, Clifford DB, Zaborski L, Tselis A, Sidtis JJ, Cohen B, Hall CD, Erice A, Henry K (1999). Neurological outcomes in late HIV infection: adverse impact of neurological impairment on survival and protective effect of antiviral therapy. AIDS Clinical Trial Group and Neurological AIDS Research Consortium study team. AIDS 13: 1677–1685.CrossRefPubMedGoogle Scholar
  30. Reyes MG, Faraldi F, Senseng CS, Flowers C, Fariello R (1991). Nigral degeneration in acquired immune deficiency syndrome (AIDS). Acta Neuropathol 82: 39–44.CrossRefPubMedGoogle Scholar
  31. Sacktor NC, Lyles RH, Skolasky RL, Anderson DE, McArthur JC, McFarlane G, Scines OA, Becker JT, Cohen B, Wesch J, Miller EN (1999). Combination antiretroviral therapy improves psychomotor speed performance in HIV-seropositive homosexual men. Multicenter AIDS Cohort Study (MACS). Neurology 52: 1640–1647.PubMedGoogle Scholar
  32. Sardar AM, Czudek C, Reynolds GP (1996). Dopamine deficits in the brain: the neurochemical basis of parkinsonian symptoms in AIDS. Neuroreport 7: 910–912.CrossRefPubMedGoogle Scholar
  33. Scines OA, Galai N, McArthur JC, Cohn S, Royal W, 3rd, Esposito D, Vlahov D (1997). HIV infection and cognition in intravenous drug users: long-term follow-up. Neurology 48: 223–230.Google Scholar
  34. Villemagne V, Yuan J, Wong DF, Dannals RF, Hatzidimitriou G, Mathews WB, Ravert HT, Musachio J, McCann UD, Ricaurte GA (1998). Brain dopamine neurotoxicity in baboons treated with doses of methamphetamine comparable to those recreationally abused by humans: evidence from [11C]WIN-35,428 positron emission tomography studies and direct in vitro determinations. J Neurosci 18: 419–427.PubMedGoogle Scholar
  35. Wilson JM, Kalasinsky KS, Levey AI, Bergeron C, Reiber G, Anthony RM, Schmunk GA, Shannak K, Haycock JW, Kish SJ (1996a). Striatal dopamine nerve terminal markers in human, chronic methamphetamine users. Nat Med 2: 699–703.CrossRefPubMedGoogle Scholar
  36. Wilson JM, Levey AI, Bergeron C, Kalasinsky K, Ang L, Peretti F, Adams VI, Smialek J, Anderson WR, Shannak K, Deck J, Niznik HB, Kish SJ (1996b). Striatal dopamine, dopamine transporter, and vesicular monoamine transporter in chronic cocaine users. Ann Neurol 40: 428–439.CrossRefPubMedGoogle Scholar

Copyright information

© Taylor & Francis Ltd 2001

Authors and Affiliations

  • Avindra Nath
    • 1
    • 2
  • William F. Maragos
    • 1
    • 3
  • Malcolm J. Avison
    • 1
  • Frederick A. Schmitt
    • 1
  • Joseph R. Berger
    • 1
  1. 1.Department of NeurologyUniversity of KentuckyLexingtonUSA
  2. 2.Department of Microbiology and ImmunologyUniversity of KentuckyLexingtonUSA
  3. 3.Anatomy and NeurobiologyUniversity of KentuckyLexingtonUSA

Personalised recommendations