Journal of NeuroVirology

, Volume 14, Issue 5, pp 362–367

Aging exacerbates extrapyramidal motor signs in the era of highly active antiretroviral therapy

  • Victor Valcour
  • Michael R. Watters
  • Andrew E. Williams
  • Ned Sacktor
  • Aaron McMurtray
  • Cecilia Shikuma
Article

Abstract

The phenotype of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) in the developed world has changed with the broad institution of highly active antiretroviral theray (HAART) and with aging of the HIV+ population. Extrapyramidal motor signs were a prominent feature of HAND as defined in the early stages of the epidemic but has not been reevaluated in the era of HAART. Moreover, the contribution of aging to extrapyramidal motor signs in the context of HIV remains undefined. We examined these questions among the 229 HIV+ participants in the Hawaii Aging with HIV Cohort compared to age-, gender-, and ethnicity-matched HIV-negative controls. Extrapyramidal motor signs were quantified using the motor exam of the Unified Parkinson’s Disease Rating Scale (UPDRSmotor) and compared to concurrent neuropsychological and clinical cognitive diagnostic categorization. The mean UPDRSmotor score increased with older age (1.68 versus 3.35; P <.001) and with HIV status (1.18 versus 3.56; P <.001). Age group (P =.024), HIV status (P <.001), and the interaction between age and HIV (P =.026) were significantly associated with UPDRSmotor score. Among HIV+ patients, the mean UPDRSmotor score increased with worsening cognitive diagnostic category (P <.001) where it was 2.06 (2.31) in normal cognition (n = 110), 3.21 (3.48) in minor cognitive motor disorder (MCMD) (n = 84), and 5.72 (5.01) in HIV-associated dementia (HAD) (n = 37). We conclude that extrapyramidal motor signs are increased in HIV in the era of HAART and that the impact of HIV on extrapyramidal motor signs is exacerbated by aging. These results highlight the importance of a careful neurological examination in the evaluation of HIV patients.

Keywords

age HIV UPDRS 

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Copyright information

© Journal of NeuroVirology, Inc. 2008

Authors and Affiliations

  • Victor Valcour
    • 1
    • 2
  • Michael R. Watters
    • 3
  • Andrew E. Williams
    • 4
  • Ned Sacktor
    • 5
  • Aaron McMurtray
    • 1
  • Cecilia Shikuma
    • 1
  1. 1.Hawaii AIDS Clinical Research Program, John A. Burns School of MedicineUniversity of HawaiiHonoluluUSA
  2. 2.Memory and Aging Center, Department of NeurologyUCSFSan FranciscoUSA
  3. 3.Division of Neurology, Department of MedicineUniversity of HawaiiHonoluluUSA
  4. 4.Kaiser PermanenteHonoluluUSA
  5. 5.Department of NeurologyJohns Hopkins UniversityBaltimoreUSA

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