NEUROLOGIC COMPLICATIONS OF AIDS

Abstract

BACKGROUND- Neurologic complications of acquired immunodeficiency syndrome (AIDS) are diverse and include opportunistic infections of the central and peripheral nervous systems, lymphoma, and primary neurologic disorders directly related to human immunodeficiency virus-1 (HIV-1) infection. REVIEW SUMMARY- This article will review the etiology, pathogenesis, clinical features, and treatment of the most common opportunistic infections of the central and peripheral nervous systems in patients with AIDS. These include toxoplasmic encephalitis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, syphilis, and cytomegalovirus infection. Primary central nervous system lymphoma occurs in patients with AIDS more frequently than in the general population but may be decreasing in incidence with the advent of highly active antiretroviral therapy. Primary neurologic disorders, which result from direct or indirect effects of HIV infection on the nervous system, will be reviewed. These include HIV-related dementia, myelopathy, and neuropathy. Understanding the pathophysiology of these entities is important to develop effective treatments. CONCLUSIONS- AIDS-related neurologic disease is a significant cause of morbidity and mortality. However, a growing number of neurologic disorders can now be treated with highly active antiretroviral therapy, and increasing use of these agents has led to a significant decline in the incidence of opportunistic infections of the nervous system and primary neurologic disorders, such as HIV-related dementia. (THE NEUROLOGIST 7:82-97, 2001)