Acquired immunodeficiency syndrome (AIDS). II. Clinical aspects with special reference to neuropsychiatric manifestations

Abstract

Opportunistic infections and neoplasias, which led to the identification and characterisation of AIDS, are the most common manifestations of this disease. The present review gives a comprehensive presentation of the current knowledge on the opportunistic infectious agents concerned and on the resulting clinical pictures with special emphasis on neuropsychiatric symptomatology. Prior to the development of the full syndrome of AIDS, a number of intermediate steps can be observed, the most important of which is persistent generalised lymphadenopathy (PGL). For all stages of the disease, problems of clinical course, risk of transmission, and prognosis are discussed in detail. Neuropsychiatric manifestations of AIDS can occur as sequelae of opportunistic infections, AIDS-associated neoplastic processes or of the retrovirus infection itself. In a number of cases neuropsychiatric manifestations are the presenting symptoms of the disease. Since neuropsychiatric symptoms such as organic brain syndrome or dementia represent crucial determinants of prognosis, they have to be considered in the planning of long-term care for the AIDS patient. Due to certain epidemiological features such as an exponential increase of its incidence during the last few years and the preferential occurrence in homosexuals and drug addicts, AIDS has brought about a number of important psychosocial effects. Since an efficient chemotherapy is not yet available and long-term prognosis is poor, AIDS patients often become isolated, and even medical professionals avoid to have contact with them. To reduce an exaggerated fear of being infected by the AIDS virus and to gain the competence for realistic assessment of the remaining risks, it is necessary to acquire a profound knowledge of the disease.