AIDS and HIV: neurologic manifestations and complications

David R Renner MD (Dr. Renner of the University of Utah has no relevant financial relationships to disclose.)
John E Greenlee MD, editor. (Dr. Greenlee of the University of Utah School of Medicine received an honorarium from Merck for authorship.)
Originally released January 5, 2015; last updated January 22, 2017; expires January 22, 2020

Overview

Since the start of the HIV epidemic, more than 70 million people have been infected with the virus, and 35 million have died from complications of HIV. At the end of 2015, 36.7 million people were living with HIV infection globally; this information can be accessed atwww.who.int. Although approximately 0.8% of adults between 15 to 49 years of age worldwide are infected with HIV, the burden of the epidemic is concentrated in Sub-Saharan Africa, where nearly 1 in 25 adults is living with HIV. Combination antiretroviral therapy (cART) was introduced in 1996, and where these drugs are available there has been great success in both treatment and prevention. The incidence of opportunistic infections declined from 13.1 per 1000 in 1996-1997 to 1 per 1000 in 2006-2007, and since 1999 the worldwide annual incidence has declined by 19% (Tan et al 2012). Despite success in treatment, neurologic complications continue to be seen in those living with HIV. In this article, the authors highlight major points of HIV-associated neurocognitive disorders (HAND), distal symmetric polyneuropathy, opportunistic CNS disease and immune reconstitution inflammatory syndrome (IRIS). The authors also provide key references for more detailed information.

Key points

 

• The introduction of cART altered the clinical presentation of HIV-associated neurocognitive disorder, requiring a reappraisal of the research diagnostic classification system. HIV-associated neurocognitive disorder comprises 3 entities: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia.

 

• Despite apparent good viremic control by cART, there seems to be progressive damage to the central nervous system as evidenced by substantial numbers of patients who still have either asymptomatic neurocognitive impairment or mild neurocognitive disorder.

 

• Virus in the CNS may escape therapy and act as a reservoir for viral persistence and evolution of drug resistance, a concept called viral escape.

 

• Another problem commonly encountered in HIV is a distal, symmetric, mixed small and large fiber polyneuropathy.

 

• Immune reconstitution inflammatory syndrome occurs due to an abnormally exuberant response of the recovering immune system to residual pathogen antigens in the CNS.

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