Cerebellar Degeneration Associated with HIV Infection

Objectives . To describe the features of the clinical picture and estimate the incidence of HIV-associated cerebellar degeneration in patients with progressive cerebellar ataxia. Materials and methods . A total of 377 patients with progressive cerebellar ataxia were examined using brain MRI, the Scale for the Assessment and Rating of Ataxia (SARA), and screening for cognitive impairment using the Montreal Cognitive Assessment test (MoCa). Autoimmune, deficiency, and other causes of ataxia, opportunistic infections, multiple system atrophy, and common forms of hereditary spinocerebellar ataxia were excluded in patients with HIV infection. Results . Five patients (1.3%) with combined ataxia and HIV infection were identified (two men, three women, aged 31–52 years). The median duration of HIV infection was five years and the duration of ataxia was one year. The clinical picture included not only progressive ataxia, but also pyramidal signs, dysphagia, and, less commonly, ophthalmoparesis, dystonia, postural hand tremor, and affective and moderate cognitive impairment. Brain MRI scans revealed signs of olivopontocerebellar atrophy in three patients and degeneration of the cerebellum (mainly the vermis) in two. All patients received combined antiretroviral therapy in various regimens, though despite this, ataxia was progressive. Conclusions . HIV infection is a rare cause of cerebellar degeneration. This diagnosis remains a diagnosis of exclusion. Cerebellar degeneration can occur and progress even after achieving stable remission of HIV infection on the background of highly active antiretroviral therapy.