Neurological Manifestations of HIV Infection

Abstract

Early studies1,2 showed that approximately 40% of patients with acquired immunodeficiency syndrome (AIDS) had neurological symptoms at some stage of their illness and that about 10% presented with neurological abnormalities-. However, neuropatho­ logical studies on postmortem material from AIDS patients have demonstrated abnormalities in a much higher proportiorr-. There is significant regional variation in the prevalence of certain neurological complications of HIV infection, eg cryptococcal meningitis being more common in New York than in the rest of the USA whereas the prevalence of progressive multifocalleucoencephalopathy appears to be uniforms, It is now apparent that any part of the neuro-axis may be affected following infection with HIV, albeit that the underlying pathological pathway in many conditions remains obscure, uncertainty also exists as to whether some neurological, neuropathological, or neuropsychiatric abnormalities can occur in HIV infectionwhich is otherwise asymptomatic or whether they are only related to advanced disease7- 11• The nervous system may be affected directly by HIV, opportunistic infection, neoplasia occurring secondary to immunodeficiency, by vascular events due to effects of HIV at sites remote to the nervous system, and as a complication of drug therapy. Multiple pathologies may occur within the nervous system, and while some syndromes are thought to be caused by a single infective agent, coinfection may be of importance in some individuals.