Neurologic complications of HIV disease and their treatment

Top HIV Med. 2009 Apr-May;17(2):46-56.

Abstract

Substantial work on the peripheral and central nervous system complications of HIV was presented at the 16th Conference on Retroviruses and Opportunistic Infections. Six studies of more than 4500 volunteers identified that distal sensory polyneuropathy remains common, ranging from 19% to 66%, with variation based on disease stage, type of antiretroviral therapy, age, and height. Eight studies of more than 2500 volunteers identified that neurocognitive disorders are also common, ranging from 25% to 69%, with variation based on stage of disease, antiretroviral use, diabetes mellitus, and coinfection with hepatitis viruses. Therapy-focused studies identified that resistance testing of cerebrospinal fluid (CSF)-derived HIV may improve management of people with HIV-associated neurologic complications, that poorly penetrating antiretroviral therapy is associated with persistent low-level HIV RNA in CSF, and that efavirenz concentrations in CSF are low but in the therapeutic range in most individuals. Neuroimaging reports identified that people living with HIV had abnormal findings on magnetic resonance imaging (gray matter atrophy, abnormal white matter), magnetic resonance spectroscopy (lower neuronal metabolites), and blood-oxygen-level dependent functional magnetic resonance imaging (lower cerebral blood flow). Other important findings on the basic neuroscience of HIV and diagnosis and management of neurologic opportunistic infections are discussed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS Dementia Complex / drug therapy
  • AIDS Dementia Complex / physiopathology
  • Anti-HIV Agents / therapeutic use
  • Central Nervous System Diseases / drug therapy
  • Central Nervous System Diseases / physiopathology
  • Central Nervous System Diseases / virology
  • HIV Infections / complications*
  • Humans
  • Leukoencephalopathy, Progressive Multifocal / drug therapy
  • Leukoencephalopathy, Progressive Multifocal / physiopathology
  • Meningitis, Cryptococcal / diagnosis
  • Meningitis, Cryptococcal / drug therapy
  • Nervous System Diseases / drug therapy
  • Nervous System Diseases / physiopathology
  • Nervous System Diseases / virology*
  • Polyneuropathies / drug therapy
  • Polyneuropathies / physiopathology
  • Polyneuropathies / virology

Substances

  • Anti-HIV Agents