Review of the neurological aspects of HIV infection

Paruk, Hoosain; Bhigjee, Ahmed Iqbal

doi:10.1016/j.jns.2021.117453

Cited by 9 publications

(4 citation statements)

References 126 publications

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Section: Discussionmentioning

confidence: 99%

“…Despite the observed decline of Cryptococcal meningitis in patients with HIV/AIDS, its occurrence still represents a determinant of poor prognosis in HIV-infected patients [3,5,6]. The presence of Cryptococcosis in the central nervous system leads to severe neurological complications [2,3,7,10]. In recent years, great advances have been described in development of laboratory techniques for the diagnosis of infectious diseases and in the emergence of new methodologies for the diagnosis of Cryptococcus spp., especially in HIV-positive individuals [21][22][23][24][25][26]28,[32][33][34][35][36]40,41].…”

Section: Discussionmentioning

confidence: 99%

“…About 70% of individuals with HIV/AIDS develop neurological disease, and this is the initial manifestation of this infection in 10-20% of cases. Despite the gradual decline in HIV/AIDS cases, neurological manifestations of this infection remain common and are a significant cause of morbidity and mortality [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Comparative analysis of diagnostic methods for the detection of Cryptococcus neoformans meningitis

Dantas

Freitas-Xavier

Lombardi³

et al. 2023

PLoS Negl Trop Dis

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Background Cryptococcosis is a devastating opportunistic infection in immunocompromised individuals, primarily in people living with HIV/AIDS. This study evaluated a protocol for the early diagnosis of meningitis due to C. neoformans, utilizing established molecular techniques from serum and CSF samples. Methods The 18S and 5.8S (rDNA-ITS) sequence-specific nested PCR assays were compared with direct India ink staining and the latex agglutination test for detection of C. neoformans in serum and cerebrospinal fluid (CSF) from 49 Brazilian suspected meningitis patients. Results were validated with samples obtained from 10 patients negative for cryptococcosis and HIV, and by analysis of standard C. neoformans strains. Principal findings The 5.8S DNA-ITS PCR was more sensitive (89–100%) and specific (100%) than the 18S rDNA PCR and conventional tests (India ink staining and latex agglutination) for identification of C. neoformans. While the 18S PCR exhibited a sensitivity (72%) similar to that of the latex agglutination assay in serum samples, it was superior to the latex agglutination assay when testing CSF, with a sensitivity of 84%. However, the latex agglutination was superior to the 18SrDNA PCR in specificity in CSF (92%). The 5.8S DNA-ITS PCR yielded the highest levels of accuracy (96–100%) of any test for detection (serological and mycological) of C. neoformans in both serum and CSF. Conclusion Use of the nested 5.8S PCR was superior to other techniques for the diagnosis of cryptococcosis. The possibility of using serum, a non-invasively collected material, in a targeted 5.8S PCR analysis to identify Cryptococcus spp. is recommended, especially in immunosuppressed patients. Our results indicate that nested 5.8S PCR can increase the diagnostic capability of cryptococcosis, and we suggest its use to monitor patients in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparative analysis of diagnostic methods for the detection of Cryptococcus neoformans meningitis

Dantas

Freitas-Xavier

Lombardi³

et al. 2023

PLoS Negl Trop Dis

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“…4 The presence of HIV viral RNA in the CNS is a topic of interest due to its correlation with, and potential resemblance to, other neurological symptomatology experienced by PLHIV which may be associated with opportunistic infections. 9 Since CSF viral escape is a rare clinical phenomenon, we performed a systematic review of case reports/series to provide a comprehensive insight into the clinical presentation, diagnosis, management, and outcomes associated with this condition.…”

mentioning

confidence: 99%

Cerebrospinal fluid viral escape in HIV patients on antiretroviral therapy: A systematic review of reported cases

Nyondo,

Njiro,

Bwire

2024

Reviews in Medical Virology

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Cerebrospinal fluid (CSF) viral escape rarely occurs when HIV is detected in the CSF, while it is undetectable in the blood plasma or detectable in CSF at levels that exceed those in the blood plasma. We conducted this review to comprehensively synthesise its clinical presentation, diagnosis, management strategies and treatment outcomes. A review registered with PROSPERO (CRD42023475311) searched evidence across PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar to gather articles (case reports/series) that report on CSF viral escape in people living with HIV (PLHIV) on antiretroviral therapy (ART). The quality of studies was assessed based on the domains of selection, ascertainment, causality, and reporting. A systematic search identified 493 articles and 27 studies that include 21 case reports, and six case series were involved in the review. The studies reported 62 cases of CSF viral escape in PLHIV. The majority were men (66.67%), with a median age of 43 (range: 28–73) years. Approximately, 31 distinct symptoms were documented, mostly being cognitive dysfunction, gait abnormalities, and tremors (12.51%). Diagnosis involved blood and CSF analysis, magnetic resonance imaging, and neuropsychological assessments. Over 36 ART regimens were employed, with a focus on ART intensification; almost one‐third of the regimens contained Raltegravir (integrase strand transfer inhibitor). The outcomes showed 64.49% full recovery, 30.16% partial recovery, and 4.76% died. When neuropsychological symptoms manifest in PLHIV, monitoring for CSF viral escape is essential, regardless of plasma viral suppression. Personalised treatment strategies, particularly ART intensification, are strongly advised for optimising treatment outcomes in PLHIV diagnosed with CSF HIV escape.

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