HIV-Associated Neurocognitive Disorder: Pathogenesis and Therapeutic Opportunities
A number of studies have shown that HIV infection is associated with decreased olfactory ability. Additionally, it has been hypothesized that a reduced odorant identification may precede the advent of AIDS Dementia Complex (ADC). However, it is not known whether changes in olfactory ability are a manifestation of neurocognitive decline which may precede the appearance of AIDS Dementia Complex, damage to the peripheral olfactory system from opportunistic infection, or whether olfactory structures have a particular sensitivity to HIV. These issues were addressed in a cross-sectional study examining variability in the neuropsychological, neurological, otolaryngological, auditory, and olfactory status in HIV-positive subjects. A stepwise regression provided evidence that the ability to identify odorants was influenced by age, nasal structure and pathology, neurocognitive ability, and level of AIDS Dementia Complex. On the other hand, only nasal pathologies accounted for the variability in olfactory thresholds. These data suggest that identification and thresholds tests may reflect different olfactory pathologies. Additionally, these data suggest at least part of the decline in olfactory ability accompanying an HIV infection may be secondary to nasal pathologies. Because of their rapidly changing neurocognitive status, HIV-positive patients represent an excellent group in which to study the determinants of olfactory ability.