Objective: To describe the clinical features of Persons living with HIV (PLH) with Parkinson’s disease

Background: Parkinson’s disease is a disease of ageing(1) .  As the life expectancy of PLH in South Africa increases due to widely available antiretroviral therapy (ART) we are likely to see an increase of PD in this population(2). There are 7 million PLH in South Africa (3). Prior to the ART rollout, Parkinsonism was described in PLH due to opportunistic infections, dopamine antagonist or HIV associated Parkinsonism (4). There is a complex interaction between HIV and the development of Parkinsonism. Dopamine concentrations in the nigrostriatal pathway are reduced in HIV infected persons (4). HIV protein Tat inhibits the synthesis of dopamine and gp120 causes excitotoxic dopamine neuronal loss via generation of reactive oxygen species (5, 6). There is hypersensitivity to dopamine receptor blockade(4). Resolution of Parkinsonism in PLH has been described after ART initiation (7). The interaction between HIV, ART , PD and PD medications in case reports suggests that PD in PLH occurs earlier and responds well to dopaminergic treatment (8). We describe our series of patients with HIV and PD.

Method: Between 2002 and 2016 there were 643 patients coded as Parkinson’s disease (ICD 10 G20). The United Kingdom Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria was used to diagnose PD. PLH were identified by two positive HIV ELISA tests. Our Neurology services are at a Tertiary Hospital in Durban, South Africa with a population of 11 million persons.

Results: Twenty three patients were coded as PD and were HIV positive. Nine were excluded, 2 patients had HIV associated neurocognitive disorder, 1 Dementia with Lewy Bodies, 1 Drug Induced Parkinsonism, 3 atypical Parkinsonism , 1 vascular Parkinsonism and 1 patient only attended once.Fourteen PD patients were HIV positive with a nadir CD4 count of 272 cells/µL. The mean age at onset (AAO) of PD was 56 years (range 27-65), 9 were Males and 13 were on ART’s. Viral load was lower than detectable in 7 patients. Mean LEDD was 675mg after a mean PD symptom duration of 5 years. The AAO was lower than the HIV negative PD patients (mean=59 years). There was no difference in LEDD and mean Hoehn and Yahr score at last visit.

Conclusion: Conclusion:PD in PLH presents at a younger age with a good response to dopamine replacement therapy.

References: 1. Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386(9996):896-912. 2. Bor J, Herbst AJ, Newell ML, Barnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961-5. 3. Statistics South Africa. Mid-Year estimates 2016 2016, August 25 [Available from: https://www.statssa.gov.za/publications/P0302/P03022016.pdf. 4. Koutsilieri E, Sopper S, Scheller C, ter Meulen V, Riederer P. Parkinsonism in HIV dementia. J Neural Transm (Vienna). 2002;109(5-6):767-75. 5. Louboutin JP, Reyes BA, Agrawal L, Van Bockstaele EJ, Strayer DS. HIV-1 gp120-induced neuroinflammation: relationship to neuron loss and protection by rSV40-delivered antioxidant enzymes. Exp Neurol. 2010;221(1):231-45. 6. Agrawal L, Louboutin JP, Marusich E, Reyes BA, Van Bockstaele EJ, Strayer DS. Dopaminergic neurotoxicity of HIV-1 gp120: reactive oxygen species as signaling intermediates. Brain Res. 2010;1306:116-30. 7. Kobylecki C, Silverdale MA, Varma A, Dick JP, Kellett MW. HIV-associated Parkinsonism with levodopa-induced dyskinesia and response to highly-active antiretroviral therapy. Mov Disord. 2009;24(16):2441-2. 8. Moulignier A, Gueguen A, Lescure FX, Ziegler M, Girard PM, Cardon B, et al. Does HIV Infection Alter Parkinson Disease? J Acquir Immune Defic Syndr. 2015;70(2):129-36.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsonism-in-hiv-positive-persons-in-south-africa/