Global HIV neurology: a comprehensive review (original) (raw)

International NeuroAIDS: prospects of HIV-1 associated neurological complications

Cell Research, 2005

Neurological complications associated with HIV-1/AIDS are being recognized with a high frequency that parallels the increased number of AIDS cases. The early infiltration by HIV-1 into the nervous system can cause primary and/or secondary neurological complications. The most common neurocognitive disorder is AIDS Dementia Complex (ADC). In developing countries of Asia the three most opportunistic infections are tuberculosis (TB), cryptococcosis, and Pneumocystis carinii pneumonia. Therefore, it is expected that secondary neurological complications due to TB and cryptococcosis will be the most common cause of morbility and mortality in HIV-1/AIDS cases in China. Research of NeuroAIDS in China is necessary to understand the impact and the biology of HIV-1 in the nervous system. Future studies would include, the molecular epidemiology and the description of opportunistic infections associated to HIV-1; the neuropathological description of primary and secondary HIV-1 complications in different groups; the HIV-1 neurotropism and immune response studies for China's unique HIV-1 strains and recombinant forms derived from the nervous system, including experimental models such as the use of transgenic rats; and the study of potential resistant virus, primarily when the anti-retroviral therapy (ART) has not full access in the brain.

Human Immunodeficiency Virus and the Central Nervous System

Annual Review of Microbiology, 1992

The pandemic of HIV/AIDS continues to grow daily. Incident cases among women, intravenous drug users and ethnic minorities comprise the fastest growing segment of the HIV-infected population, and the number of HIV-infected individuals over the age of 50 is growing rapidly. Today, the central nervous system and the immune system are seen as main targets of HIV infection. Significant progress in the knowledge and treatment of AIDS has been obtained in recent years. The neurological manifestations directly related to HIV are acute viral meningitis, chronic meningitis, HIV-associated dementia (HAD), vacuolar myelopathy, and involvement of the peripheral nervous system.

Human Immunodeficiency Virus And The Nervous System: An Update With Emphasis On Developing Countries

Benin Journal of Postgraduate Medicine, 2009

Ten percent of patients that are diagnosed with AIDS also have some neurological complaint, 40% present neurological signs or symptoms during the course of the infection, and 80% of the autopsies present neurological alterations. Although much is known about the neuropathology of HIV infection, many important questions on its neuropathogenesis remain unanswered.

Neurologic complications of HIV disease and their treatment

Topics in HIV medicine : a publication of the International AIDS Society, USA

Important new information regarding neurologic complications of HIV disease was presented at the 2007 Conference on Retroviruses and Opportunistic Infections. In addition to presentations on pathogenesis and treatment of neurologic complications, the conference included findings that have implications for the management of HIV disease outside the nervous system. Key findings included that the distribution of antiretrovirals into the central nervous system may influence the effectiveness of treatment outside this protected compartment; that postponing initiation of therapy until blood CD4+ counts fall to 300 cells/mm3 may increase the risk for HIV-associated neurocognitive impairment but interruption of antiretroviral therapy in individuals with high CD4+ counts may have neuropsychologic benefits; that substantial changes, including macrophage activation and neuronal injury can occur shortly after HIV transmission; that HIV can influence neural progenitor cells to decrease neuronal d...

Antiretroviral penetration into the CNS and incidence of AIDS-defining neurologic conditions

Neurology, 2014

Objective: The link between CNS penetration of antiretrovirals and AIDS-defining neurologic disorders remains largely unknown. Methods: HIV-infected, antiretroviral therapy-naive individuals in the HIV-CAUSAL Collaboration who started an antiretroviral regimen were classified according to the CNS Penetration Effectiveness (CPE) score of their initial regimen into low (,8), medium (8-9), or high (.9) CPE score. We estimated "intention-to-treat" hazard ratios of 4 neuroAIDS conditions for baseline regimens with high and medium CPE scores compared with regimens with a low score. We used inverse probability weighting to adjust for potential bias due to infrequent follow-up. Results: A total of 61,938 individuals were followed for a median (interquartile range) of 37 (18, 70) months. During follow-up, there were 235 cases of HIV dementia, 169 cases of toxoplasmosis, 128 cases of cryptococcal meningitis, and 141 cases of progressive multifocal leukoencephalopathy. The hazard ratio (95% confidence interval) for initiating a combined antiretroviral therapy regimen with a high vs low CPE score was 1.74 (1.15, 2.65) for HIV dementia, 0.90 (0.50, 1.62) for toxoplasmosis, 1.13 (0.61, 2.11) for cryptococcal meningitis, and 1.32 (0.71, 2.47) for progressive multifocal leukoencephalopathy. The respective hazard ratios (95% confidence intervals) for a medium vs low CPE score were 1.

Clinical profile of neurological manifestation in Human Immunodeficiency Virus-positive patients

North American Journal of Medical Sciences, 2012

Human Immunodeficiency Virus (HIV) infection is a global pandemic. According to the data released by UNAIDS in 2007, India had 2.5 million people living with HIV infection. [1] Next to sub-Saharan Africa, it has the second largest burden of HIV-related illness. Though the main targets of HIV infection are the cells of the immune system, the nervous system is often damaged during the course of infection, not only by disease processes that are secondary to immune dysfunction but also by more fundamental effects of the retrovirus. Neurological disease is the first manifestation of symptomatic HIV infection in roughly 10-20% of patients, while about 60% of patients with advanced HIV disease will have clinically evident neurological dysfunction. [2-4] Autopsy studies of patients with advanced HIV disease have demonstrated pathologic abnormalities of the nervous system in 75-90% of cases, [2,5,6] thus proving that the incidence of subclinical neurological disease is even higher. This may be explained by the fact that the central nervous system (CNS) is a sanctuary site for HIV infection and there is poor CNS penetration of antiviral drugs due to the presence of intact blood brain barrier. [2] We undertook this study to see the prevalence of the various neurological manifestations in HIV-positive admitted patients who presented to a tertiary hospital in our setup.

Neurological Manifestations of HIV

Advances in HIV and AIDS Control, 2018

Neurological manifestations of human immunodeficiency virus (HIV) infection are common in certain regions of the world, notably Sub-Saharan Africa. The chapter highlights the neurotropism and neurovirulence of HIV underlying its direct neuropathology. The high frequency of neurological HIV disease is discussed in respect with the different viral clades. Sub-Saharan Africa is highlighted as bearing the brunt of the HIV pandemic. An approach to neurological HIV disease is given with a sensible classification system of manifestations and complications according to the level of immune suppression, primary HIV-related versus secondary opportunistic conditions, and other metabolic, drug induced, nutritional, or unrelated causes. Major manifestations of neuro-HIV are aseptic meningitis, HIV-associated neurocognitive disorders, HIV myelopathies and pediatric HIV-associated CNS disease; these are discussed in detail, and reference is made to the discrepancy of available data and literature between the so-called developed and developing countries. The role of antiretroviral treatment and its potential limitation in reaching the CNS compartment is stressed.