Cerebellar Degeneration and Progressive Ataxia Associated With HIV-Virus Infection (P1.078)

Objective: To describe a case series of four patients with cerebellar degeneration associated with HIV infection. Background: The spectrum of neurologic disorders associated with human immunodeficiency virus (HIV) is very broad. It can be divided into those that result from direct HIV infection, opportunistic infections of the nervous system, primary central nervous system lymphoma and other malignancies, toxic effects of therapies, and others1. The common neurodegenerative conditions which include HIV virus as a trigger, include HIV-dementia complex and amyotrophic lateral sclerosis (ALS)2,3. Some few reports have demonstrated the relationship between progressive ataxia and cerebellar degeneration in HIV patients. The exact pathophysiological mechanisms of ataxia in HIV patients is not very clear yet. Design/Methods: A cohort of ataxia patients (N = 1.050) was evaluated from 2008 to 2017, in order to determine the etiology of the ataxia. This sample included several causes as hereditary and sporadic ataxias. Results: We identified 4 patients as presenting progressive ataxia, cerebellar atrophy and positive test for HIV. Secondary and neurodegenerative causes and most common hereditary ataxias (Friedreich and spinocerebellar ataxias) were ruled out. No patient had opportunistic infectious or neoplastic that might justify the cerebellar involvement. Samples underwent duplicate PCR (blood, cerebrospinal fluid and urine) and all were negative for JC virus. We had no evidence to consider that ataxia symptoms were caused by Highly active antiretroviral therapy (HAART). Conclusions: HIV infection should be investigated in adult patients with undetermined sporadic progressive pure ataxia and cerebellar atrophy. Pathophysiological may involve cerebellar degeneration instead of autoimmune or medication toxic effects, similar to neurodegeneration observed in ALS and HIV-dementia complex. Disclosure: Dr. DRUMOND GAMA has nothing to disclose. Dr. Vale has nothing to disclose. Dr. Pedroso has nothing to disclose. Dr. Ribas has nothing to disclose. Dr. Kristochik has nothing to disclose. Dr. Domingues da Silva Fink has nothing to disclose. Dr. Penalva de Oliveira has nothing to disclose. Dr. Teive has nothing to disclose. Dr. Barsottini has nothing to disclose.