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  • Updated 02.09.2022
  • Released 10.31.2018
  • Expires For CME 02.09.2025

AIDS and HIV: neurologic manifestations and complications

Introduction

Overview

Of the almost 38 million people living with HIV worldwide at the end of 2020, it is estimated that at some point in their disease, over 50% will experience neurologic complications directly or indirectly attributable to HIV or its treatment (115; 143). The neurologic manifestations experienced by people living with HIV are diverse, affecting every aspect of the central and peripheral nervous systems, and can be mediated by direct viral invasion, immunologic dysregulation, opportunistic infections, or antiretroviral therapy side effects (Table 1). Neurologists should be familiar with HIV-associated neurologic complications to enable timely, precise diagnosis and treatment.

Table 1. Neurologic Manifestations Associated with HIV Infection

Central nervous system disorders

Peripheral nervous system disorders

Headache

HIV-associated neurocognitive disorders

Meningitis or encephalitis

Cerebrovascular disease

Seizures

Neuro-ophthalmologic disease

Movement disorders

Demyelinating disorders
• Acute disseminated encephalomyelitis
• Neuromyelitis optica spectrum disorder
• Multiple sclerosis-like syndrome

Sleep disorders

Spinal cord disorders
• Vacuolar myelopathy
• Myelitis

Polyneuropathy
• Distal sensory polyneuropathy
• Antiretroviral toxic neuropathy
• Autonomic neuropathy
• Diffuse infiltrative lymphocytosis syndrome
• Nutritional polyneuropathy (B12, B6)

Inflammatory demyelinating polyradiculoneuropathy

Polyradiculopathy
• Syphilis
• Tuberculous
• Cytomegalovirus
• Lymphomatous
• HIV-related
• Varicella zoster virus

Neuropathies
• Facial neuropathy

Mononeuritis multiplex
• HIV-related
• Hepatitis C virus-related
• Hepatitis B virus-related

Muscle disorders
• Rhabdomyolysis
• HIV-associated polymyositis
• Inclusion-body myositis
• Nemaline rod myopathy
• Toxic myopathy, zidovudine

Opportunistic infections associated with HIV infection

Cryptococcal meningitis
• Cerebral toxoplasmosis
• Tuberculous meningitis
• Cytomegalovirus
• Progressive multifocal leukoencephalopathy

Key points

• HIV can affect the entire nervous system, including the brain, spinal cord, peripheral nerve, and muscle.


• The most common neurologic manifestations of HIV are HIV-associated neurocognitive disorders and polyneuropathy; however, diseases traditionally associated with aging (eg, cerebrovascular disease) are becoming increasingly important.


• Neurologists should be aware of specific neurologically relevant toxicities and drug-drug interactions associated with antiretroviral therapy.


• Neurologic manifestations of immune reconstitution inflammatory syndrome must be recognized when people living with HIV are started on antiretroviral therapy.

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