Neurologic Complications of Human Immunodeficiency Virus

Abstract

PURPOSE OF REVIEW: This article reviews the neurologic complications associated with human immunodeficiency virus (HIV) infection.RECENT FINDINGS: Neurologic complications of HIV may be caused by direct virally mediated pathology, immune-mediated phenomena in response to viral infection, or opportunistic infections secondary to depletion of lymphocytes. These neurologic disorders may be influenced by the degree of immunosuppression (ie, CD4+ T-cell lymphocyte count) and stage of infection (early versus late), as well as use of antiretroviral therapy, and may manifest as a variety of central and peripheral neurologic syndromes, including the more commonly encountered HIV-associated cognitive disorders and length-dependent sensorimotor polyneuropathy, respectively. Immune dysregulation underlies the majority of these neurologic phenomena, as well as other HIV-associated conditions including immune reconstitution inflammatory syndrome (IRIS), CD8 lymphocytosis, and potentially the development of compartmentalized infection within the CSF, also referred to as CSF escape.SUMMARY: This article reviews a spectrum of clinical syndromes and related neuropathologic states associated with HIV infection.

Unusual Types of Plasma Cell Dyscrasias Associated With HIV: Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes (POEMS) Syndrome

“…Indeed, ACD is defined as an increased protein level (>0.45 g/L) in the absence of elevated white cell count (<50 cells/μL). Due to the exclusion of the main opportunistic infections via PCR in our case, this mild pleocytosis corresponds to aseptic meningitis, which is common and usually asymptomatic among HIV patients [ 5 ].…”

Infections of the Spine and Spinal Cord

“…In patients with HIV developing myelitis after initiation of antiretroviral therapy, the cause may be immune reconstitution inflammatory syndrome (IRIS) rather than a primary infection. For further discussion, refer to the article “Neurologic Complications of Human Immunodeficiency Virus” by Marie F. Grill, MD, 107 in this issue of Continuum .…”

Infections of the Peripheral Nervous System

“…58 Length-Dependent Axonal Polyneuropathy Infectious causes of length-dependent axonal sensory or sensorimotor polyneuropathy include HIV, hepatitis C virus, leprosy, and HTLV-I. This type of neuropathy is the most common peripheral manifestation of HIV, but it is still important to rule out other common causes of peripheral neuropathy in patients with HIV 59 ; for more details, refer to the article "Neurologic Complications of Human Immunodeficiency Virus" by Marie F. Grill, MD, 60 in this issue of Continuum. Lyme disease has also been cited to cause a chronic, distal, CASE 5-1 A 60-year-old man presented for neurologic evaluation of 3 years of bilateral hand numbness.…”