Cerebellar degeneration associated with HIV infection
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To the Editor:
HIV type 1 (HIV-1) infection can produce neurologic complications such as dementia, myelopathy, and peripheral neuropathy. Tagliati et al.1 described 10 such patients with symptoms of cerebellar dysfunction that they similarly ascribed to HIV-1 infection. These patients were screened for toxic and neoplastic etiologies of cerebellar degeneration. However, no genetic testing was performed. This sample was quite heterogeneous. Although ataxia was present in all 10 patients, and dysmetria in 9, other cerebellar symptoms including tremor (4 patients), nystagmus (3 patients), and dysdiadochokinesis (6 patients) were less prevalent. Radiologic imaging showed severe cerebellar atrophy in 4 patients, and mild-moderate atrophy in 3 others. Imaging was not performed on 3 patients. Pathologic studies demonstrated cerebellar granular cell loss in only 2 out of 3 autopsied patients. Do such variegated data truly define an HIV-1 related cerebellar disorder? The following report demonstrates that HIV-1–infected individuals may have superimposed genetic disorders that need to be excluded before concluding such a syndrome exists.
A 33-year-old man presented in October 1998 with a 1-year history of progressive gait ataxia, dysarthria, and clumsiness. HIV-1 infection had been diagnosed in 1985. He denied any history of alcohol or drug use or opportunistic infections. His viral load was undetectable (less than 50 copies per milliliter) and his CD4 count was 733 cells per mm3. A brain MRI in August 1998 showed …
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