Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Human Immunodeficiency Virus Type 1 (HIV-1) Huntington’s Disease 735

■CD4 and viral load help predict prognosis.

■Age, genetics, and physician’s experience with HIV care were only

population-based variables affecting natural history (older age at

HIV infection and less physician experience associated with worse

outcomes)

■Since introduction of HAART, 2-year AIDS survival increased from

34% to 70% in 1997; African-Americans and Latinos not benefiting

as much as others

Huntington’s Disease.................................

CHAD CHRISTINE, MD

history & physical

■Gradual onset of chorea, dementia or both

■Family history (autosomal dominant inheritance)

■Onset at any age, typically btwn 30–50 years of age

■Early cognitive changes of moodiness, antisocial behavior & later

dementia

■Movement disorder

➣Restlessness or frank chorea

➣In childhood-onset cases, progressive rigidity & akinesia pre-

dominate

tests

■Laboratory: blood & urine testing is normal; genetic testing is avail-

able

■Imaging: CT or MRI may show atrophy of cerebral cortex & caudate

nucleus

differential diagnosis

■Drug-induced chorea (stimulants, estrogen, neuroleptics, dopamin-

ergics, anticonvulsants, opiates, antihistamines), benign hereditary

chorea, chorea-acanthocytosis, paroxysmal choreoathetosis differ-

entiated by history

■Wilson’s disease excluded clinically & if necessary by slit-lamp exam-

ination of cornea & by testing for serum ceruloplasmin & 24-hour

urine for copper

■Stroke, brain tumor, cerebral vasculitis excluded by history & brain

imaging