Evaluation of HIV-related mental status changes

insidious and progressive cognitive decline without affecting work performance, homemaking, or social functioning; can be elicited using the 3 questions from the European AIDS Clinical Society guidelines[54]European AIDS Clinical Society. Guidelines: version 11.1 October 2022 [internet publication]. http://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html

mild difficulties in neuropsychological testing, afebrile, absence of systemic illness or focal neurologic deficit

progressive cognitive decline, impaired ability affecting work performance, homemaking, or social functioning

mild to moderate difficulties in neuropsychological testing, afebrile, absence of systemic illness or focal neurologic deficit

receiving combination antiretroviral therapy; persistent dysphoric mood, distress, anxiety, irritability, cognitive difficulties, sleep and appetite disturbances, fatigue, psychomotor retardation

problems with attention, concentration, and recent memory, psychomotor slowing, agitation; afebrile; absence of focal neurologic deficits

history of toxoplasmosis with positive serology; not receiving effective combination antiretroviral therapy; fever and malaise; nausea, vomiting and headache; confusion, speech difficulty, seizures, behavioral changes

focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances and seizures

history of cryptococcal infection; not receiving effective combination antiretroviral therapy; acute or subacute onset; progressive headache and fever, nausea, vomiting, behavioral change, confusion, photophobia, drowsiness, and seizures

reduced visual acuity, papilledema, cranial nerve palsies and other focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), involuntary movements (myoclonus and tremors), sensory disturbances, and seizures

history of tuberculosis (TB); headache, meningismus, meningeal signs (photophobia, neck rigidity), if accompanying non-meningeal involvement: shortness of breath, cough, lymphadenopathy, abdominal pain, dysuria; fever, chills, weight loss, night sweats

pulmonary: tachypnea, decreased breath sounds, crackles, dullness to percussion, pleural effusion; extrapulmonary: findings dependent upon site, lymphadenopathy common

persistent dysphoric mood, distress, anxiety, irritability, feeling hopeless, loss of self-esteem, anhedonia (loss of interest in usual activities); poor concentration, sleep and appetite disturbances, fatigue, psychomotor retardation, recurrent thoughts of death

sadness, irritability, psychomotor slowing, agitation; afebrile; absence of systemic illness or focal neurologic deficit

history of use of opiates, cocaine, amphetamines, sedatives; nausea, jitteriness, trouble concentrating, anxiety, paranoia, and euphoria; seizures, delirium, hallucinations

evidence of injection (needle marks, scars, skin necrosis); nasal septal defects; tremulousness, agitation, irritability/mood lability

history of harmful use of alcohol and alcohol dependence; seizures, delirium, hallucinations

confusion, tremor, odor of alcoholic beverage on breath, stigmata of liver disease (spider angiomata, gynecomastia, hepatomegaly)

history of hepatitis C infection, treatment with interferon; insidious onset of nonspecific symptoms (e.g., fatigue and malaise); depression, psychosis, anxiety, confusion, somnolence, and poor concentration

stigmata of liver disease (spider angiomata, gynecomastia, hepatomegaly), ascites, jaundice, icteric sclera, ankle edema, cognitive impairment, hepatic encephalopathy

history of hepatitis B infection; insidious onset of nonspecific symptoms (e.g., fatigue and malaise); depression, psychosis, anxiety, confusion, somnolence, and poor concentration

stigmata of liver disease (spider angiomata, gynecomastia, hepatomegaly), ascites, jaundice, icteric sclera, ankle edema, cognitive impairment, hepatic encephalopathy

history of delayed or absent puberty; infertility; diminished libido; loss of spontaneous morning erections; erectile dysfunction

micropenis, underdeveloped scrotum or bifid scrotum, gynecomastia

global impairment in cognition; patient may not report any symptoms; marked impairment in performing daily activities; can be elicited using the 3 questions from the European AIDS Clinical Society guidelines[54]European AIDS Clinical Society. Guidelines: version 11.1 October 2022 [internet publication]. http://www.eacsociety.org/guidelines/eacs-guidelines/eacs-guidelines.html

delayed speech output with long pauses between words, poor thought; flat or labile affect, apathy and social withdrawal; gait abnormalities and a reduction in motor movements; frontal release signs, spasticity, and brisk deep tendon reflexes; afebrile; absence of systemic illness

recent initiation of combination antiretroviral therapy (ART); fever, night sweats, weight loss; cough; neurologic deterioration

lymphadenopathy/lymphadenitis, hepatosplenomegaly; variety of chest signs, depends on severity of lung involvement: may include tachypnea, decreased breath sounds, crackles, dullness to percussion

rash (often on palms or soles), headache, meningismus, blurred vision, photophobia, reduced color perception, seizures, or cognitive dysfunction, in late tertiary syphilis: personality change, gait impairment, incontinence

genital chancre or oral mucous patch, rash, uveitis, hyporeflexia, ataxia, anisocoria, Argyll Robertson pupils, cranial neuropathy, motor or sensory deficits, dementia, paranoia

history of CMV infection; not receiving effective combination antiretroviral therapy; fever and malaise; nausea, vomiting and headache; visual upset, confusion, speech difficulty, seizures, behavioral changes

focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances, and seizures

not receiving effective combination antiretroviral therapy; insidious onset of cognitive impairment, behavioral changes, motor and visual impairment

cognitive impairment; focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances, and seizures

history of herpes virus infection (must still be considered even if prior history of herpes infection is absent); fever, altered mental status, and neurologic focal signs

cognitive impairment; focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances, and seizures

history of varicella infection; not receiving effective combination antiretroviral therapy; fever, altered mental status, and neurologic focal signs

cognitive impairment; focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances, and seizures

not receiving effective combination antiretroviral therapy; unexplained headache, change in vision or motor function, poor coordination, ataxia, seizures; nausea, vertigo, sudden deafness

focal neurologic deficits; hemiparesis, ataxia, pyramidal signs (brisk tendon reflexes, extensor plantar responses), cranial nerve deficits, involuntary movements (myoclonus and tremors), visual field defects, sensory disturbances, and seizures

cognitive impairment (e.g., irritability, apathy, somnolence, suspiciousness, emotional instability, confusion); paresthesias, memory loss, gait disturbances

lower extremity numbness, gait unsteadiness, hyporeflexia, positive Babinski sign, ataxia, peripheral neuropathy, atrophic glossitis

history of cardiac disease or syphilis; acute changes in mental status likely; associated with neurologic symptoms: unilateral weakness or numbness; change in vision (unilateral or bilateral); difficulty with speech, comprehension; loss of coordination, difficulty walking; severe headache

confusion frequently noted; focal neurologic signs include: unilateral hemiparesis, hemianopia, aphasia, ataxia; cardiac failure

weakness, lethargy, slow speech, cold sensation, forgetfulness, constipation, and weight gain

coarse, dry skin; eyelid edema; thick tongue; facial edema; bradycardia

history of autoimmune disease, HIV infection, possible tuberculosis infection, history of use of drugs that inhibit cortisol production (particularly coadministration with ritonavir or cobicistat); fatigue, weakness; there may be muscle weakness and myalgias; anorexia and weight loss; gastrointestinal symptoms may be present, including nausea, vomiting, constipation, and abdominal pain

significant weight loss secondary to anorexia, mucosal and cutaneous hyperpigmentation; postural hypotension may be present; other signs of autoimmunity, such as vitiligo, Hashimoto thyroiditis, and pernicious anemia may be present