NeuroAIDS in sub-Saharan Africa: A clinical review

Abstract

NeuroAIDS affects half of the 22 million people currently living with HIV/AIDS in sub-Saharan Africa, where cryptococcal meningitis alone is responsible for 504,000 deaths annually. A good understanding of NeuroAIDS may help improve disease-free survival in patients at risk and optimize resource utilization by caregivers. In this review, we aimed to provide a summary of major NeuroAIDS syndromes of relevance in Africa. We searched Medline for English language literature to identify relevant publications, using the search terms "NeuroAIDS" and "HIV AND nervous system." The most common NeuroAIDS syndrome is HIV-associated neurocognitive disorders (HAND), which affects over 1.5 million Africans yearly. While incidence of HAND has decreased with the use of highly active antiretroviral therapy, prevalence has increased due to longer life expectancy. Other NeuroAIDS syndromes include tuberculous meningitis and intracerebral tuberculoma, cryptococcal meningitis, toxoplasma encephalitis, progressive multifocal leukoencephalopathy, primary central nervous system lymphoma, stroke, and distal sensory polyneuropathy. NeuroAIDS care and research in Africa are hindered by resource limitations. Inadequate neuroimaging and laboratory facilities result in diagnostic delays and confusion, while limited access to drugs leads to inappropriate treatment. However, the situation may be improving. Better funding of HIV care by African governments and donor agencies have resulted in decreasing HIV prevalence and prolonged survival. Yet, central nervous system opportunistic infections remain important causes of death and disability among African patients with HIV/AIDS. There is the need for additional funding to improve access to antibiotics and to facilitate further research into NeuroAIDS and its treatment.

Viral and cellular factors underlying neuropathogenesis in HIV associated neurocognitive disorders (HAND)

“…However, recent clinical studies and a meta-analysis [1,166,167] in patients on HAART revealed milder forms of neurological dysfunction (ANI & MND) in greater than half of HIV-positive patients. In studies examining individuals with ART-controlled HIV viremia, HIV DNA in PBMCs correlated with regional brain atrophy highlighting the contribution of peripheral viral reservoirs to CNS pathology [168].…”

Intellectual Impairment in Patients with Newly Diagnosed HIV Infection in Southwestern Nigeria

“…Sub-Saharan Africa is the most heavily affected region in the world with estimated 1.9 of the 2.5 million new HIV infections worldwide in 2011 [ 1 ]. Most of the fatal courses remain in the context of late diagnosis of HIV infection and delayed initiation of antiretroviral therapy (ART) [ 2 , 3 ].…”

Manifestaciones Neurológicas en Pacientes Ambulatorios con Diagnóstico de VIH Atendidos en el Hospital Carlos Andrade Marín.

“…metástasis, tuberculosis) y no compresivas (ej. mielitis, paraparesia espástica tropical, mielopatía vacuolar) basados en la urgencia del manejo [33,34]; se estima que la mielopatía vacuolar afecta a un tercio de los portadores del VIH y causa molestias relevantes al 1-5% [35]. Los estudios neurofisiológicos han detectado Tabla 2.…”

“…A pesar de esto los resultados se aproximan a los obtenidos en estudios previos de otros sitios del mundo [3]. En la actualidad, los esfuerzos en investigación se enfocan en el ictus, leucoencefalopatía multifocal progresiva, demencia asociada al VIH y aumento de resistencia al tratamiento; sin embargo, se consideran problemas importantes la disponibilidad de fármacos, falta de programas de detección y derivados de la sociedad como la estigmatización y discriminación de los pacientes [34].…”