Dizziness and Cognitive Impairment in Parkinson's Disease Among HIV Patients: Case Report

Abstract

Parkinsonism affects approximately 5% of individuals with HIV and represents the most common movement disorder in this population. It often coexists with HIV-associated neurocognitive disorder (HAND), opportunistic infections, or neuroleptic use. Accurate diagnosis of HIV-associated dementia (HAD) is crucial, as it is an AIDS-defining condition that may be reversible with antiretroviral therapy (ART).  This case report aims to describe a patient with HIV who presented with dizziness, progressive cognitive decline, and parkinsonian features, highlighting the diagnostic challenges and the role of ART in management.  A 41-year-old male with known HIV infection presented with progressive memory loss, dizziness, postural instability, bradykinesia, and intention tremors over several months. Neurological examination revealed cognitive impairment (MMSE 22/30) and parkinsonism (UPDRS-III 76/108). Brain MRI showed cerebral atrophy, white matter changes, and an abnormal “swallow tail” sign bilaterally in the substantia nigra, suggestive of Parkinson’s disease. Laboratory tests demonstrated adequate systemic viral suppression (CD4 302 cells/µL).  The patient was diagnosed with HIV-associated dementia and Parkinson’s disease. His ART regimen was modified to enhance CNS penetration (zidovudine, lamivudine, dolutegravir). At two-month follow-up, he showed significant improvement in cognitive function and reduced dizziness, enabling return to work and daily activities. HIV-associated neurocognitive disorder and parkinsonism can occur even with well-controlled systemic HIV infection. A high index of suspicion, comprehensive neuropsychological and neuroimaging assessment, and individualized CNS-targeted ART are essential for optimal outcome.