HIV-associated parkinsonism reversed with antiretroviral therapy

Human immunodeficiency virus (HIV) infection can cause variable movement disorders, including parkinsonism. HIV-related parkinsonism usually responds well to highly-active antiretroviral therapy (HAART), suggesting a possible reversible dysfunction of the dopaminergic system. We report the case of a 42-year-old man who presented with rapidly progressive symmetric parkinsonism, cognitive decline, and loss of postural reflex as the initial manifestation of HIV infection. A significant improvement of his parkinsonism after HAART demonstrates a potentially reversible dopaminergic system dysfunction secondary to HIV infection. A normal Tc-TRODAT-1 SPECT image after HAART treatment paralleled the clinical improvement in extrapyramidal symptoms. Early identification of HIV-related parkinsonism, especially in patients with symmetrical akinetic-rigidity and early loss of posture reflex, is important for its potential reversibility with HAART therapy. Neurology Asia 2014; 19(2) : 199 – 203 Address correspondence to: Dr. Chin-Hsien Lin, Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan. Tel: +886-2-23123456 ext 65335, Fax: +886-2-23418395, E-mail: [email protected] INTRODUCTION Movement disorders, including hemichoreaballimus, myoclonus, dystonia, tremor, and parkinsonism, are not rare in human immunodeficiency virus (HIV)-associated central nervous system (CNS) complications. Parkinsonism, either isolated or secondary to prior exposure to neuroleptic agents or intracerebral opportunistic infections, occurs in up to 5% of patients with HIV infection. Isolated parkinsonism as a primary initial manifestation of HIV infection has rarely been reported. Whether the nigro-striatal dysfunction in HIV-related parkinsonism is reversible after highly-active antiretroviral therapy (HAART) remains unclear. Single photon emission computed tomography (SPECT) of dopamine transporters with Tc-TRODA-1 is a valuable and feasible means of assessing the integrity of dopamine neurons. Here, we report a case of HIV infection with parkinsonism as the presenting feature in which extrapyramidal symptoms improved significantly after HAART without dopaminergic drugs. The Tc-TRODAT-1 SPECT image showed intact dopamine transporter uptake in the bilateral basal ganglia.