Acceleration of HIV dementia with methamphetamine and cocaine

We report a patient with rapidly accelerating HIV dementia accompanied by s eizures and an unusual movement disorder despite highly potent antiretrovir al therapy. This clinical constellation was associated with the non-parente ral use of methamphetamine and cocaine. Fractional enhancement time on post contrast magnetic resonance imaging studies revealed a progressive breakdo wn of the blood brain barrier particularly in the basal ganglia. The moveme nt disorder but not the dementia responded to a combination of dopamine rep lacement and anticholinergic therapy. While the movement disorder may have been unmasked by concomitant anticonvulsant therapy, we suggest in this ins tance, that prior drug abuse synergized with HIV to cause a domino effect o n cerebral function. Careful attention and analysis to histories of remote noninjecting drug abuse may help substantiate our hypothesis.