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. 2008 Oct;14(5):362-7.
doi: 10.1080/13550280802216494. Epub 2008 Nov 12.

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

Victor Valcour  1 , Michael R Watters, Andrew E Williams, Ned Sacktor, Aaron McMurtray, Cecilia Shikuma
Affiliations

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

Victor Valcour et al. J Neurovirol. 2008 Oct.

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 therapy (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.

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Figures

Figure 1
Figure 1
Unified Parkinson Disease Rating Scale Motor Exam (UPDRSmotor) by HAHC Arm
Figure 2
Figure 2
Frequency of extrapyramidal motor signs by study arm.
Figure 3
Figure 3
Unified Parkinson Disease Rating Scale Motor Exam by Age Group and Cognitive Diagnosis
See this image and copyright information in PMC

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