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Central Nervous System Complications in HIV

Overview

Based on current World Health Organization (WHO) statistics, there are more than 36 million people living with human immunodeficiency virus (HIV) today. More than 19 million of them receive antiretroviral therapy (ART).
 Despite the increased life longevity of patients infected with HIV, neurologic complications remain common. Infection with HIV can affect both the peripheral and central nervous systems (CNS) in their entirety as well as muscles. With the advancement and greater availability of ART, CNS complications due to opportunistic infections as a result of severe immunocompromise have decreased. However, manifestations of neurologic dysfunction not caused by opportunistic infections (primary manifestations) are still prevalent.
 

Complications of the nervous system can occur in more than 40% of patients with HIV. Aseptic meningitis and acute demyelinating polyneuropathy (AIDP) can be the presenting symptoms of acute HIV infection. Aseptic meningitis can be seen in as many as 25% of patients and can occur within 10–20 days of systemic infection. In 10–20% of cases, neurologic manifestations are the presenting signs/symptoms of AIDS. At autopsy, the prevalence of neuropathologic abnormalities is 80%.

Types of Neurologic Complications

As mentioned above, neurologic complications that are associated with HIV infection include those caused directly by the virus and others caused through indirect mechanisms.

CNS manifestations include the following:

HIV-associated neurocognitive disorder (HAND)

Vacuolar myelopathy

Cerebrovascular disease

Aseptic Meningitis

Peripheral nervous system/muscle manifestations include the following:

Peripheral neuropathies

Myopathies

Conditions caused by infectious, autoimmune, neoplastic processes secondary to immunodeficiency or those related to treatment include:

CNS lymphoma

Immune Reconstitution Inflammatory Syndrome of the CNS (CNS-IRIS)

Kaposi sarcoma

Progressive multifocal leukoencephalopathy (PML)

Fungal infections (eg, cryptococcal meningitis, Penicillium marneffei encephalitis)

Tuberculous meningitis

Cytomegalovirus (CMV) encephalitis

In addition, HIV-infected patients are susceptible to the same neurologic diseases as patients without infection.

In AIDS, a clinical presentation often cannot be explained with a single diagnosis. New-onset neurologic complications often are superimposed on an ongoing process with a different etiology. Clinical features reflect the sum of deficits at several anatomic sites.

CNS Complications in Children

The manifestations of AIDS and its neurologic complications differ in children, whose immune and nervous systems are infected at an immature stage, whether in utero, during delivery, or postpartum. CNS complications tend to progress more rapidly in children, probably because of the inability of their immune systems to mount an appropriate T-cell, B-cell, or cytokine response to the infection.

Neurologic involvement in HIV infection is more frequent in children than in adults. It may take the form of a loss of previously acquired intellectual and motor milestones or of developmental delay. Opportunistic infections due to reactivation of dormant organisms are unusual, as children may not have been exposed yet to the responsible organisms. Distinguishing features include blood vessel calcification in the basal ganglia, large necrotizing cortical and subcortical lesions, microcephaly, and infection of astrocytes.

Patient Education Information

For patient education information, see the Dementia Center, Immune System Center, and Sexually Transmitted Diseases Center, as well as Dementia Due to HIV Infection and HIV/AIDS.

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