HIV-associated parkinsonism reversed with antiretroviral therapy

ABSTRACT

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 99mTc-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.