From January 2016 to December 2021, twenty-six (26) patients were listed and hospitalized in the Neurology and Psychiatry departments of Conakry University Hospital. The duration of the disease was not specified because of the socio-cultural conceptions that surround mental illnesses which make all these patients first consult traditional medicine for several months [13]. The average age is 48.5 years with extremes of 44 to 67 years, including 12 women and 14 men. In the history, the risk factors for probable transmission were identified in 13 patients: high number of partners with polygamy (2 to 4) women in 9 cases, drug addiction and chronic alcoholism by local alcoholic substances 3 cases, anal intercourse by homosexuality 1 case. The use of condoms during sexual intercourse: vaginal, anal, orogenital was not identified in any patient. Six (6) patients certified in their antecedents the presence of genital lesions in probable connection with a sexually transmitted disease not identified biologically.
The clinical signs at the onset and status phase are summarized in Table I. It appears throughout our series that the infectious picture was listed in 16 patients during evolution.
Table I
Clinical signs at onset and status phase
Clinical signs at the onset phase | Percentage |
- Early irritability with emotional control disorder | 15 (57.9%) |
- Social disinterest by refusal of assistance in official traditional ceremonies | 13 (50%) |
- Apathy | 8(30.7%) |
- Signs of sadness with slowed ideation | 8(30.7%) |
- Disgust with life with loss of interest | 7(26.9%) |
- Insomnia, evening remission | 11 (42.3%) |
- Weight loss, loss of libido | 6(23%) |
Clinical signs at status phase | |
- Memory problems (working memory, episodic memory) | 26(100%) |
- Dysphonic disorders (change, frequent mood, unmotivated crying) | 21(80.7%) |
- Personality disorders self-blame, anxiety, feelings of guilt | 22(84.7%) |
- Motor signs (tremor, pyramidal signs) | 21 (80.7) |
- Tonic-clonic epileptiform seizures | 2 (5.5%) |
Using the dementia syndrome results of Price and Werley, our patients were received at admission according to the following stages: Stage 1 3 patients (11.5%), stage 2: 9 patients (34.6%), stage 3: 11 patients 42.3%, stage 4: 3 patients (11.5%).
This classification shows that our patients are received at advanced stages due to delays in consultation, the first link of which goes through traditional medicine.
Biological Data:
NFS, ESR, glycaemia and transaminases biological data were normal in 16 patients and a mild hypochromic microcytic anemia was noted in 10 patients with an average hemoglobin level of 7.80 ± 2.2 g/dl. In the CSF, the count and the total proteins were almost unremarkable, except in 4 patients who had a slight variant proteinorachia between 0.42 and 0.82g/l and all the patients presented with normo-glycorachia. The PCR reactions on CSF of HSV1 and 2, VZV, EBV, CMV, enterovirus, HHV6, ADH were negative as well as the PCR reactions on CSF of pneumococcus, meningococcus and Lyme, syphilis, listeria (CSF and blood) negative.
The dosages of vitamin B1 in the context of Gayet Wernické encephalopathy and of B12 were found to be normal. All patients at the time of hospitalization had a TCD 4 lymphocyte count greater than 350/mm³.
Electroencephalographic Data:
Type I and II tracings, expression of non-specific alterations in brain bioelectrical activity were observed in 18 patients (70%) and in 8 patients (30%), the tracing reflected type III of our classification ( Figs. 1, 2).
Neuroradiological Data:
The 26 patients with a clinical picture of AIDS dementia underwent cerebral and MRI allowing differential diagnosis with vascular dementia and other subcortical dementias. In 3 cases, the MRI was normal and in 23 cases (84.5%), the MRI revealed diffuse white matter abnormalities such as hyperintensities on the T2-weighted sequences or flair without abnormality on the sequences. weighted in T1 (Fig. 3, 4, 5, 6, 7,8,9,10).
Evolution:
All patients received antiretroviral treatment (ATRIPLAT). After discharge from the hospital, seven patients were lost to follow-up and the prognostic evolution was not possible. In thirteen patients reviewed at six months and 12 months of regular follow-up, the clinical symptoms and the MRI abnormalities regressed. The picture remained stationary with significant cognitive impairment and loss of autonomy in three patients and the three others died of acute pneumonitis and malaria.