Abstract

We report a case of a 41-year-old female who presented with complaints of irritability, visual hallucinations, wandering episodes and disinhibition following a trivial familial stressor. This case highlights the importance of in-depth assessment of symptoms and investigating the cause. Human Immunodeficiency Virus (HIV) has profound neuropsychiatric consequences. HIV enters the brain early during infection through infected monocytes/macrophages via a 'Trojan horse' mechanism and infects resident glial cells, especially microglia and astrocytes. These cells then secrete neurotoxins, including gp120 and Tat protein, which trigger a cascade of neuroinflammatory responses, oxidative stress, and apoptosis, leading to synaptic loss and neuronal damage. HIV-associated neurocognitive disorders (HAND) encompass a spectrum from asymptomatic neurocognitive impairment (ANI) to mild neurocognitive disorder (MND) and HIV-associated dementia (HAD). Although the incidence of opportunistic CNS infections has declined with ART, HAND remains. Psychiatric manifestations of HIV-related CNS involvement may include mood disturbances, psychosis, cognitive decline, delirium, or even catatonia. These symptoms may be the first presentation of HIV, especially in individuals without previous psychiatric history. Given the stigma, diagnostic delay, and limited awareness, cases like the one presented here may go undiagnosed or misdiagnosed as primary psychiatric illness.

Key words: Asymptomatic neurocognitive impairment, HIV-associated dementia, HIV-associated neurocognitive disorders, Human Immunodeficiency Virus (HIV), Mild neurocognitive disorder