Guidelines for the diagnosis and management of neurological complications of HIV infection

Portegies, Peter; Solod, L.; Cinque, Paola; Chaudhuri, Abhijit; Begovać, Josip; Everall, Ian; Weber, Thomas K.; Bojar, Martin; Martinez‐Martín, Pablo; Kennedy, Peter G. E.

doi:10.1111/j.1468-1331.2004.00856.x

Cited by 103 publications

(81 citation statements)

References 60 publications

(43 reference statements)

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“…Highly active antiretroviral therapy (HAART) has failed to eliminate this aspect of HIV-1-associated disease, and in fact the prevalence of HIV dementia has increased in the post-HAART era, possibly because of HAART's positive effects on overall patient survival time [23][24][25]. It has further been suggested that HAART may be altering the presentation and/or pathogenesis of HIV dementia, resulting in a more slowly progressive, chronic form of the disease [23][24][25]. These observations highlight the need for new, adjunct therapeutic approaches aimed specifically at ameliorating or preventing HIV dementia.…”

Section: Introductionmentioning

confidence: 99%

HIV-1-based defective lentiviral vectors efficiently transduce human monocytes-derived macrophages and suppress replication of wild-type HIV-1

et al. 2005

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Background-Human monocytes play an important role in mediating human immunodeficiency virus type 1 (HIV-1) infection of the central nervous system (CNS), and monocytes-derived macrophages (MDM) represent a major viral reservoir within the brain and other target organs. Current gene transduction of MDM is hindered by a limited efficiency. In this study we established a lentiviral vector-based technique for improved gene transfer into human MDM cultures in vitro and demonstrated significant protection of transduced MDM from super-infection with wild-type HIV-1.

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Section: Introductionmentioning

confidence: 99%

HIV-1-based defective lentiviral vectors efficiently transduce human monocytes-derived macrophages and suppress replication of wild-type HIV-1

et al. 2005

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“…In this setting, minimally invasive diagnosis using CSF-PCR for CMV DNA is particularly useful. This tool showed 62-100% sensitivity and 89-100% of specificity in CMV encephalitis and polyradiculopathy 29 , and present positive and negative predictive values ranged between 86-95% and 95-98%, respectively [7][8][9] .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment recommendations to neurologic CMV complications are diverse, but most suggest ganciclovir, foscarnet or both agents in combination 9,13,14,17,19,27,29,34 and highlight that initiating therapy promptly is critical for an optimal clinical response. Some authors recommend combination therapy in all cases 11,20 or in patients who have received prior antiviral therapy for CMV or in patients with disease progression under monotherapy 22,34 .…”

Section: Discussionmentioning

confidence: 99%

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Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Silva

Oliveira

Vilas-Boas

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69%) were men. At admission all patients were aware of their HIV status and only four (31%) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62%) patients. The neurologic syndromes identified were diffuse encephalitis (n = 7; 62%), polyradiculopathy (n = 7; 54%), focal encephalitis (rhombencephalitis) (n = 1; 8%), and ventriculo-encephalitis (n = 1; 8%). Seven (54%) patients presented extra-neural CMV disease and four (31%) had retinitis. The median of CD4+ T-cell count was 13 cells/µL (range: 1-124 cells/µL). Overall in-hospital mortality was 38%. Eight patients used ganciclovir or foscarnet (in-hospital mortality: 50%) and five patients used ganciclovir and foscarnet (in-hospital mortality: 20%). None of the patients fulfilled the diagnosis criteria of immune reconstitution inflammatory syndrome. Four patients were lost to follow-up, and three patients presented immune recovery and discontinued secondary prophylaxis. Although infrequent, distinct neurological syndromes caused by CMV continue to cause high mortality among AIDS patients. Survival depends upon the use of effective antiviral therapy against CMV and the early introduction of HAART.

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“…tório que envolve as estruturas situadas no espaço subaracnóideo da base do crânio, podendo promover bloqueio da circulação do líquido cefalorraqueano (LCR), determinando aumento da pre s s ã o intracraniana e alterações no exame do LCR 5 . No presente estudo, os relatamos um caso meningite tuberculosa que evoluiu com bloqueio do fluxo do LCR.…”

Section: Um Terço Da População Mundial Está Infectada C O M O M Y C Ounclassified

Localização da lesão e achados do líquido cefalorraqueano na meningite tuberculosa: diferenças nos compartimentos lombar, cisternal e ventricular

Heringer

Fernandes

Goncalves

et al. 2005

Arq. Neuro-Psiquiatr.

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A meningite tuberculosa, doença infecciosa do sistema nervoso central (SNC) causada pelo Mycobacterium tuberc u l o s i s, apresenta-se como uma c o mplicação precoce da tuberculose primária (primoinfecção), ocorrendo mais freqüentemente nos prim e i ros seis meses após a infecção 1 . A tuberculose p e rmanece como uma das doenças infecciosas mais freqüentes no mundo. Oito milhões de pessoas desenvolvem a doença e 3 milhões morrem, anualmente . R e t a rdos no d i a gnóstico e tratamento da meningite tuberculosa são f a t o res que contribuem diretamente para a alta mort a l i d a d e 4 . A decisão de tratar um paciente para meningite tuberculosa é freqüentemente empírica, independentemente das facilidades diagnósticas disponíveis aos médicos assistentes 4 . Durante o curso da doença, ocorre formação de exsudato inflama- RESUMO -A tuberculose permanece como uma das doenças infecciosas mais freqüentes no mundo. No presente estudo, relatamos um caso de meningite tuberculosa, que evoluiu com bloqueio do fluxo do líquido c e f a l o rraqueano (LCR), causando dificuldade diagnóstica. Discute-se a importância da localização da lesão e sua influência no exame do LCR como apoio ao diagnóstico da meningite tuberculosa. No caso relatado, a pesquisa do bacilo álcool-ácido resistente foi positiva no LCR cisternal e negativa no LCR lombar e ventricular, demonstrando que a maior acurácia do teste esteve relacionada a maior proximidade da lesão inflamatória.PALAVRAS-CHAVE: meningite tuberculosa, líquido cefalorraqueano, LCR, fluxo do LCR, punção cisternal.Location of the lesion and the cere b rospinal fluid findings in tuberculous meningitis: diff e re n c e s in the lumbar, cisternal and ventricular compartiments ABSTRACT -Tuberculosis remains one of the most prevalent infectious diseases worldwide. In the present s t u d y, we describe a case of tuberculous meningitis that caused cere b rospinal fluid (CSF) flow block, leading to difficulties in the diagnosis. The importance of the lesion site and its influence on CSF analysis as a support for the diagnosis of tuberculous meningitis is discussed. In this case, the search for acid-fast bacilii was positive in the cisternal CSF, but not in the ventricular and lumbar CSF, demonstrating the relationship between the accuracy of the test and the location of the inflamatory lesion disease.

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Guidelines for the diagnosis and management of neurological complications of HIV infection

Cited by 103 publications

References 60 publications

HIV-1-based defective lentiviral vectors efficiently transduce human monocytes-derived macrophages and suppress replication of wild-type HIV-1

HIV-1-based defective lentiviral vectors efficiently transduce human monocytes-derived macrophages and suppress replication of wild-type HIV-1

Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Localização da lesão e achados do líquido cefalorraqueano na meningite tuberculosa: diferenças nos compartimentos lombar, cisternal e ventricular

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