Objective: To add to the current body of knowledge of the association of HIV infection and dopamine responsive parkinsonism.

Background: South Africa has one of the highest incidence and prevalence of HIV infection in the world. More often than not, movement disorders in the HIV context in South Africa are often due to a secondary cause if not the HIV infection itself. These obvious causes often have clear associations with drugs or changes on Magnetic Resonance Imaging of the brain. Parkinsonian syndromes have been previously described in the context of HIV infection and HAART. It is well established that HIV can cause various neurocognitive disorders either primarily or secondarily by various means including opportunistic infections. In this case we describe a case of young onset parkinsonism occurring during the seroconversion phase that has progressively worsened over time. This is evident in the patient’s Unified Parkinson’s Disease Rating Scale Part III scores as well as her Trodat scan.

Methods: An analysis and description of relevant haematological, radiological and UPDRS (Unified Parkinson’s Disease Rating Scale) is used to describe and illustrate the following: 1. Exclusion of Parkinson plus syndromes. 2. Exclusion of easily identifiable secondary causes of parkinsonism. 3. Dopamine responsiveness by means of the dopamine challenge. 4. Confirmation of impaired dopamine neurophysiology by means of a 99mTc TRODAT-1 SPECT CT scan (TRODAT).

Results: Current available literature suggests that there is an increase in alpha-synuclein deposition in the substantia nigra that occurs in aging HIV infected patients although no clinical correlate has been identified for this phenomenon. The clinical data in the above case report suggests that a diagnosis of dopamine responsive idiopathic Parkinson’s disease is not unreasonable; however, its relationship to the HIV diagnosis and the seroconversion phase makes this an atypical form of secondary parkinsonism.

Conclusions: Taking into account the current available literature as well as the clinical details of our patient, we suggest that atypical Parkinson’s disease be recognised as a potential manifestation of HIV seroconversion as well as HIV neurological disorders.

References: 1. MATTOS, James Pitágoras de; ROSSO, Ana Lúcia Zuma de; CORREA, Rosalie Branco and NOVIS, Sérgio A.P.. Movement disorders in 28 HIV-infected patients. Arq. Neuro-Psiquiatr. [online]. 2002, vol.60, n.3A [cited 2018-03-14], pp.525-530. 2. Tisch S, Brew B. Parkinsonism in hiv-infected patients on highly active antiretroviral therapy. Neurology. 2009 Aug 4;73(5):401-3. DOI:10.1212/WNL.0b013e3181b04b0d.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/atypical-dopamine-responsive-parkinsonism-in-hiv-seroconversion/