HIV-related Neurocognitive Disorder with Hallucinations and Delusions: A Case Report

Background: In patients with human immunodeficiency virus (HIV) infection,HIV-associated neurocognitive disorder (HAND) occurs in 18-50% of cases. Symptoms, including memory impairment, impaired attention, concentration, executive dysfunction, slowed motor speed, apathy, personality changes, and abnormal behavior vary. However, psychotic symptoms, such as hallucinations and delusions, are rare. We report a case of HAND with hallucinations, delusions, abnormal behavior, irritability, and decreased motor and attention-processing speeds that were successfully treated with risperidone and aripiprazole. Case presentation: A 39-year-old Japanese man with a 6-year history of HIV presented to our hospital with delusions, hallucinations, and cognitive dysfunction. Five years ago, he was admitted to our department with abnormal behaviors, such as trespassing in his residence and immobility. He was diagnosed with HAND after HIV secondary brain disease was ruled out. He was admitted with auditory and visual hallucinations. However, his symptoms improved with risperidone (4 mg). Two years previously, he stopped taking risperidone and became irritable. He was admitted to our department in October of the same year with hallucinations, delusions, slow movement, and decreased spontaneity. Misperception, delusions, abnormal behavior, and prolonged response latency were observed at the time of admission. On the third day of admission, aripiprazole was administered, and the dose was titrated to 30 mg. His hallucinations, delusions, abnormal behavior, and irritability disappeared. One year later, in March, a cognitive function test showed that his motor speed, attention-information processing speed, and activity had improved. Conclusions: This patient presented with HAND hallucinations, delusions, abnormal behavior, hyperirritability, and cognitive dysfunction. Risperidone and aripiprazole effectively alleviated these symptoms, and the cognitive dysfunction showed reversible improvement. Clinicians should be aware of the possibility of hallucinations and delusions, which are rare symptoms in treating HAND. Additionally, they should consider the possibility of improved cognitive function and provide appropriate treatments.