HIV Infection Disorders Research Articles

High Levels of Monocyte Chemoattractant Protein-1 Plasma Are A Risk Factor for Neurocognitive Disorders in Human Immunodeficiency Virus Infection with Antiretroviral Therapy

Background: HIV-associated neurocognitive disorder (HAND) is a neurocognitive dysfunction caused by HIV infection. The prevalence of neurocognitive disorders of HIV in Indonesia is about 51%. Despite receiving antiretroviral therapy, HAND is still a common complication that causes morbidity in people with HIV. One of the foundations of HAND pathogenesis is inflammation. Infection of macrophages/microglia and astrocytes leads to excessive production of viral gene products and chemokines, one of them is Monocyte chemoattractant protein 1 (MCP-1). The purpose of this study was to determine plasma MCP-1 levels that increase the risk of neurocognitive disorders in HIV infection with antiretroviral therapy. Methods: This matched case-control study involved 76 subjects with HIV, 38 subjects with neurocognitive disorders, and 38 subjects without neurocognitive disorders. Cognitive status was reviewed based on MoCA-Ina examination criteria. Plasma MCP-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: Of the 76 subjects, the mean age of the case group was 42.08 ± 9.44 years and the control group was 42.16± 8.90 years. The cut point value based on the ROC curve of the plasma MCP-1 level was 82.14 pg/mL. It had an 86.8% sensitivity and 52.6% specificity for the occurrence of neurocognitive disorders in HIV. The risk of neurocognitive disorders in HIV was found in MCP-1 plasma ≥ 82.14 pg/mL (OR 7.33, p < 0.001, CI 95% = 2.35-22.83). Based on multivariate analysis, MCP-1 levels were independently associated with the incidence of neurocognitive disorders in HIV (AOR 11.01, CI 95% = 2.75-44.01, p=0.001). Conclusion: This study showed that high plasma MCP-1 levels were an event risk factor for neurocognitive disorders in HIV with antiretroviral therapy.

CD70-induced differentiation of proinflammatory Th1/17/22/GM lymphocytes associated with disease progression and immune reconstitution during HIV infection

ABSTRACT Immune overactivation is a hallmark of chronic HIV infection, which is critical to HIV pathogenesis and disease progression. The imbalance of helper T cell (Th) differentiation and subsequent cytokine dysregulation are generally considered to be the major drivers of excessive activation and inflammatory disorders in HIV infection. However, the accurate factors driving HIV-associated Th changes remained to be established. CD70, which was a costimulatory molecule, was found to increase on CD4+ T cells during HIV infection. Overexpression of CD70 on CD4+ T cells was recently reported to associate with highly pathogenic proinflammatory Th1/Th17 polarization in multiple sclerosis. Thus, the role of CD70 in the imbalance of Th polarization and immune overactivation during HIV infection needs to be investigated. Here, we found that the elevated frequency of CD70 + CD4+ T cells was negatively correlated with CD4 count and positively associated with immune activation in treatment-naïve people living with HIV (PLWH). More importantly, CD70 expression defined a population of proinflammatory Th1/17/22/GM subsets in PLWH. Blocking CD70 decreased the mRNA expression of subset-specific markers during Th1/17/22/GM polarization. Furthermore, we demonstrated that CD70 influenced the differentiation of these Th cells through STAT pathway. Finally, it was revealed that patients with a high baseline level of CD70 on CD4+ T cells exhibited a greater risk of poor immune reconstitution after antiretroviral therapy (ART) than those with low CD70. In general, our data highlighted the role of CD70 in Th1/17/22/GM differentiation during HIV infection and provided evidence for CD70 as a potential biomarker for predicting immune recovery.

The Prevalence and Determinants of Anaemia among Clients of the AIDS Support Organisation-Entebbe, Uganda

Anaemia, a common hematological disorder in HIV infection, compromises the quality of life and treatment outcomes. At The AIDS Support Organisation (TASO), Entebbe, the records for the 2016-2018 period show a 10% prevalence of anaemia which is lower than that in literature where it is said to be up to 95%. This study determined the prevalence, type, severity, and determinants of anaemia among people living with HIV and AIDS who receive care from TASO Entebbe in Uganda. A questionnaire was used to collect data from 624 TASO clients. A checklist identified the clients’ Antiretroviral Therapy (ART) combination and viral load. The selected clients’ Body Mass Index (BMI) was calculated to assess their nutritional status. A Fully Automated Humacount 60TS Three-Part Hematology Analyzer was used to measure hemoglobin and to do a full blood count. A blood film from each sample was manually examined for the type of anaemia. Data analysis was done with Stata MP 15. The prevalence of anaemia was 44.4%, and the anaemia was mostly mild (54.15%) to moderate (40.80%). Anaemia of inflammation was the commonest type (>58%). Gender, viral suppression, nutritional status, nutritional education, marital and economic status were significantly associated with the anaemia. Duration on ART had a protective effect, but this was not statistically significant. The prevalence of anaemia (44.4%) among the TASO-Entebbe Uganda clients was high, but the anaemia was mostly mild to moderate (>94%) and of inflammation type (>58%). Management of anaemia in HIV requires intentional screening since it compromises treatment outcomes.

Cross-sectional study of clinical and linguistic characteristics mental disorders in HIV infection

IntroductionCurrent epidemiological data on the pandemic prevalence of HIV in the world expand the boundaries of the problems associated with the threat of unpredictable spread of infection and the frequency of mental disorders that accompany HIV infection.ObjectivesSomatogenic mental disorders are determined by the fact that the central nervous system (CNS) is one of the reservoirs for HIV. HIV is indirectly a neurotropic virus and can cause associated neurocognitive impairment (HAND)MethodsIn study were used clinical-linguistic examination method for determining linguistic markers for mental disorders in HIV patients who did not receive specific antiviral therapy.ResultsAs a result, it was found that 50% of HIV-infected patients not suffering from addiction syndromes or surfactant abuse have mental disorders, which are characterized mainly by disorders of adaptive reactions and mild cognitive impairment. 57.7% of HIV-infected people who do not use surfactants showed a high level of social adaptation. For patients who do not use surfactants, and who have undergone a commission examination before starting ART, the leading psychopathological syndromes are anxiety, anxiety-hypochondria. 44.2% of patients did not have obvious psychopathological symptoms.ConclusionsStructure of emotional experiences was revealed in patients who recently learned about the burden of a serious chronic disease with the corresponding fear of death and self-stigmatization. Identified linguistic markers are additional signs that can be used by physicians and psychiatrists to diagnose both cognitive impairment and emotional impairment in patients with HIV infection.Conflict of interestNo significant relationships.

Characteristics of bifidobacteria biological properties in gut microflora disorders in HIV-infected children

Aim is to evaluate the biological properties of bifidobacteria in HIV-infected children with different degrees of gut microflora disorders to determine the direction for correction of bifidobacterium in HIV infection.Materials and methods. 58 selected cultures of bifidobacteria from HIV-infected children, 45 children in the comparison group. In bifidobacteria studied adhesion index of microorganisms (IAM), hydrophobicity (H), acid formation, antioxidant activity (AOA), delayed antagonism to opportunistic microorganisms.Results. In HIV-infected children at I degree of gut microflora disorders biological properties of bifidobacteria did not differ from the comparison group (p0.05). At II degree of gut microflora disorders hydrophobicity of bifidobacteria was 45,75% (33; 58.8), IaM — 2.5 (2,0; 2.9), acid formation 67,30 T (53,0; 97,4), AOA — 0.8 Eaoa (0,6; 1.0). At III degree of gut microflora disorders H — 22,7% (15.8; 46,6), iAm — 2.4 (1,92; 3,69), acid formation — 66,3 T (48,9; 94,9), AOA-0.4 Eaoa (0,3; 0,6). Value biological properties at II and III degrees of gut microflora disorders were lower than in bifidoflora from HIV-negative children (p0.01).Conclusion. At the I degree of gut microflora disorders in HIV infection it is necessary to correct the quantitative level of bifidobacteria. At II and III degree it is necessary to correct the surface properties, antioxidant and fermentation of carbohydrates activity of bifidobacteria.

Neurological disorders in HIV in Africa: a review.

Neurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa. Seminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. "Nervous System Diseases" "HIV Infections" and "Africa South of the Sahara" and "Seizures" or "Spinal Cord Diseases" or "Peripheral Nervous System Diseases" or "AIDS Dementia Complex" or "Opportunistic Infections" or "Immune Reconstitution Inflammatory Syndrome" or "Stroke". Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders. Neurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6-9-month mortality rate of 60-70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%. Neurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.

Khritinin D.F., Novikov V.V. Mental disorders in HIV infection in XXI century. Moscow: Binom, 2016

Khritinin D.F., Novikov V.V. Mental disorders in HIV infection in XXI century. Moscow: Binom, 2016

Nutritional Indices and Cardiovascular Risks Factors in HIV Infection in Southern Nigeria

Background: Viral load and specific drug related toxicities have been implicated in nutritional and metabolic disturbances in HIV infection. This study evaluated some micro, macro nutrients and cardiovascular risk factors in HIV infection with or without highly active antiretroviral therapy (HAART). Material and Methods: Ninety subjects (18-65 years) comprising of 30 sero-positive HIV on HAART, 30 sero-positive HAART naive and 30 HIV sero-negative subjects were recruited into the study. Fasting plasma glucose (FPG), total proteins (TP), albumin, vitamin C, total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) were estimated using colorimetric methods, zinc (Zn), copper (Cu) by atomic absorption spectrophotometry, CD4+ T cell count by flow cytometry while body mass index (BMI), globulin, atherogenic index of plasma (AIP), albumin/globulin ratio (A/G), very low density lipoprotein cholesterol (VLDL-C), low density lipoprotein cholesterol (LDL-C) were calculated. Data were analyzed using ANOVA, LSD post hoc at p< 0.05. Results: HIV sero-negative subjects had higher BMI, CD4-T cell count, albumin, vitamin C, Zn, LDL-C, A/G ratio and lower FPG, globulin, Cu compared to HAART naive; and higher BMI, CD4+T cell count, albumin, vitamin C, Zn with lower FPG, globulin, Cu, TG, and VLDLC compared to HIV on HAART respectively (p<0.05). HIV on HAART had increased albumin, A/G ratio, FPG, LDLC, VLDL, TG, TC and lower CD4 +T cell count, TP, globulin and Zn compared to HAART naive subjects (p<0.05). Conclusion: Disturbances in homeostasis of total proteins, antioxidant micronutrients with dyslipidemia and increased risk of cardiovascular disorders in HIV infection may be aggravated by HAART.

Cutaneous Symptoms and Rashes in Patients with HIV-Positive Infections (A Review Article)

Identifying the cutaneous symptom associated with HIV positive disease and investigating the kind of rashes can be helpful in early diagnosis of the disease. The extensity of skin disorders in HIV infection is widespread. Examination of the skin of these patients can be a good indicator of the status of the immune system as well as the patient's psychological status and also in early diagnosis can make a worthy help. We carried out a literature search (From 1990 to 2016) related to this issue through Google Scholar, Pub-MED, Scopus, Science Direct, and Iran DOC, by using keywords cutaneous symptoms, HIV positive, skin infection, warts, early diagnosis. Among 124 articles only 51 papers were related to skin infections. Review of the associated research, investigation the skin infections in HIV patients and early diagnosis made a great help in the treatment process, particularly in people with high-risk behaviors which leads to diagnosis the HIV in the early stages. The results of this study suggest the importance of cutaneous symptom in patients with HIV infection and early diagnosis to start the medical procedures.

Mental disorders in patients with HIV infection: systematics and features of development

To identify and systematize characteristics and patterns of formation and development of mental disorders in HIV-infection. Two hundred and fifty patients with HIV-infection and 50 injection drug users, aged 18-50 years, were examined. Most of HIV-infected people were aged from 21 to 40 years. In addition to clinical and psychopathological methods, clinical laboratory instrumentation and experimental psychological method were used. Mental disorders in HIV-infected patients include psychogenic-reactive, exogenous organic and personality disorders. The dynamics of these disorders depends on the combined effects of somatogenic, nosogenic and premorbid personality factors.

Baseline CD4 T Cell Level Predicts Recovery Rate after Initiation of ART in HIV Infected Nigerians

The most characteristic immunologic disorder in HIV infection is the progressive loss of CD4 T lymphocytes, thus, it remains the most important and commonly used marker for monitoring of immune status of HIV-infected individuals. This study monitored CD4 T lymphocyte cell dynamics among HIV patients on ART, and consequently defined an optimal baseline level required for enhanced ARV treatment. Ninety-eight (M = 33; F = 65) out of 106 consenting HIV-infected ARV-naïve patients enrolled and monitored for 24 months were considered in the analysis. The patients were classified into four groups based on baseline CD4 T lymphocyte cell levels, and specific parameters were evaluated at interval. Median CD4 T lymphocyte increased from 114 (Range: 6–330) at baseline to highest 357 (Range: 15–1036) cells/μL at 18 months of therapy. Fifty (51.0%), 58(59.2%), 75(76.5%), 69(70.4%), 63(64.3%), and 69(70.4%) doubled their preceding CD4 levels during the 3rd, 6th, 9th, 12th, 18th, and 24th months of ART, respectively. Maximum 337, 302, 360, and 475 cells/μL of blood were attained by groups commenced on ART with baseline CD4 ≤ 50, 51–100, 101–200, and 201–350 cells/μL of blood, respectively. The results show that higher baseline CD4 T lymphocyte cell level correlates with enhanced restoration and plateau after commencement of ART.

Invariant natural killer T (iNKT) cells in HAART-treated, HIV-positive patients with bone and cardiovascular impairment.

BackgroundInvariant Natural Killer T (iNKT) cells represent a determinant in the course of infections and diseases, however, their role in the pathogenesis of non-infectious co-morbidities in HIV-positive patients is unknown.MethodsFlow cytometry was used to investigate iNKT cell frequency, phenotype and function in HIV-infected patients on HAART with bone and/or cardiovascular disorders and in HIV-positive controls free from co-morbidities.ResultsiNKT cells from subjects with bone and cardiovascular impairment expressed high levels of CD161 and predominantly secreted TNF. iNKT cells from individuals with bone disease alone did not show any distinctive phenotypical or functional characteristics. The functional capacity of iNKT cells in patients with cardiovascular disorder was impaired with no cytokine release upon stimulation.ConclusioniNKT cells may have a role in non-infectious co-morbidities in treated HIV disease, possibly through the exacerbation of inflammation. Further studies are needed to investigate iNKT cells in the pathogenesis of non-communicable disorders in HIV infection.

Noncommunicable diseases in HIV infection in low- and middle-income countries: gastrointestinal, hepatic, and nutritional aspects.

The purpose of this review was to outline the interaction between HIV and noncommunicable diseases affecting the gastrointestinal (GI) tract, liver, and nutritional disorders in low- and middle-income countries (LMICs), and to identify research priorities. Noncommunicable GI tract disorders are only moderately influenced by HIV, and peptic ulceration is actually less common. However, the impact of HIV on GI cancers needs further investigation. HIV interacts strongly with environmental enteropathy, exacerbating malabsorption of nutrients and drugs. HIV has 2 major effects on noncommunicable liver disease: drug-induced liver injury and nonalcoholic fatty liver disease (particularly in persons of African genetic descent). The effect of HIV on nutrition was one of the first markers of the epidemic in the 1980s, and HIV continues to have major nutritional consequences. Childhood malnutrition and HIV frequently coexist in some regions, for example, southern Africa, resulting in powerful negative interactions with poorer responses to standard nutritional rehabilitation. HIV and nutritional care need to be better integrated, but many questions on how best to do this remain unanswered. Across the spectrum of GI, hepatic, and nutritional disorders in HIV infection, there is increasing evidence that the microbiome may play an important role in disease pathogenesis, but work in this area, especially in low- and middle-income countries, is in its infancy.

Cognitive impairment and major depressive disorder in HIV infection and cerebrospinal fluid biomarkers

Cognitive impairment and major depressive disorder (MDD) are common HIV-1 central nervous system (CNS) complications. Their frequencies in AIDS patients are 36% and 45%, respectively. The diagnoses of HIV cognitive impairment are made by clinical criteria, no single laboratory test or biomarker establishes the diagnosis. Factors of indirect neuronal injury related with the pathophysiology of the HIV infection in the CNS, are the factors studied as biomarkers. In the present no biomarker is established to the diagnosis of HIV cognitive impairment, much still needs to be done. We review in this paper some biomarkers in cerebrospinal fluid that could be valuable to the diagnosis of HIV cognitive impairment. Diagnosing depression in the context of HIV can be challenging, to identify a biomarker that could help in the diagnosis would be very important, although MDD risks and neurobiology are still poorly understood.

Unanswered Questions in HIV Hematology

Hematological abnormalities are common manifestations of HIV infection that are regularly encountered in the clinical setting. Although initially recognized with the first descriptions of HIV infection over 30 years ago, our understanding of the epidemiology, natural history, and treatment of these blood disorders continues to evolve. Aggressive lymphomas such as diffuse large B-cell lymphoma and primary CNS lymphoma have decreased since the introduction of combination antiretroviral therapy (cART), though these and other HIV-associated malignancies continue to a have a major impact on the morbidity and mortality of persons with HIV. Other blood disorders frequently associated with HIV include cytopenias, particularly anemia and thrombocytopenia. In this special issue, studies investigating hematologic diseases associated with HIV infection are discussed. The diagnosis, treatment, and prognosis of Hodgkin lymphoma (HL) in the era of cART are reviewed by Jacobson and Abramson. Unlike non-Hodgkin lymphomas (NHL), the incidence of HL in HIV-infected patients has not decreased in the cART era. However, the introduction of cART has allowed the delivery of full doses of chemotherapy with significantly improved outcomes. Despite these advances, patients with HIV-associated HL remain at risk of treatment-related toxicity, and interactions between antiretroviral and chemotherapeutic agents necessitate careful attention to supportive care. Two papers focus on HIV-associated Burkitt lymphoma (BL). Though the outcome of HIV-NHL has improved substantially in the cART era, the outcome of HIV-BL with standard chemotherapy remains poor. J. A. Rodrigo et al. describe the combined experience in four Canadian centers treating patients with HIV-BL with the CODOX-M/IVAC regimen with or without rituximab in the modern era. In this study, intensive chemotherapy with CODOX-M/IVAC ± R yielded acceptable toxicity and favorable survival rates. A. M. Petrich et al. review the larger picture in the treatment of HIV-BL in the paper entitled “paradigms and controversies in the treatment of HIV-related Burkitt lymphoma.” In this paper, available data on the treatment of patients with HIV-BL with current BL-directed chemotherapy regimens are discussed in detail, including Hyper-CVAD, dose-adjusted EPOCH, the PETHEMA regimen, and CODOX-M/IVAC. Areas of uncertainty in the treatment of these patients include the addition of rituximab to chemotherapy regimens, the optimal approach to patients with relapsed or refractory BL and the role of stem cell transplantation, the appropriate approach to older patients and patients with central nervous system involvement, and the role of antiretroviral therapy and supportive care. An intriguing and pressing challenge in the management of patients with both malignant and nonmalignant hematologic disorders in HIV infection is the optimal approach to be taken in the developing world. This topic is addressed by M. Ulrickson et al. in the paper “Epidemiology, diagnosis, and treatment of HIV-associated NHL in resource-limited settings.” The epidemiology of NHL in Africa is compared to that of the US, and discrepancies in survival highlighted by cancer registries are discussed. Challenges in managing patients with NHL in resource-limited settings include diagnostic challenges due to limited access to a full battery of immunohistochemical tests and limited molecular testing. Treatment challenges include limited access to antiretroviral regimens, prophylactic agents, IV infusion centers, and a higher incidence of major infectious complications including tuberculosis and hepatitis B. Response assessments are further limited by a lack of ready access to cross-sectional imaging in some regions. Despite these challenges, progress has been made in developing tolerable and effective treatment regimens appropriate to these circumstances, and these important advances are reviewed. A common nonmalignant complication of HIV infection is immune thrombocytopenia (ITP). The characteristics of HIV-associated ITP were documented prior to the cART era, and the optimal treatment beyond cART is unknown. For this reason, K. L. S. Ambler et al. present a retrospective cohort study reviewing individuals with severe HIV-associated ITP diagnosed in the cART era. Their series is the largest such report of severe HIV-ITP in the post-cART era. The major finding from this study was that, although the various treatments were well tolerated and most patients achieved a safe platelet count, nearly all patients (87%) required retreatment for recurrence of severe ITP. This highlights that new approaches to the treatment of ITP in this population are needed. The intent of this special issue was to initiate interest in and further inquiry into the many hematologic complications faced by persons living with HIV. In addition to the topics discussed in this issue, areas for future exploration include the approach to management of patients with less common lymphoproliferative disorders such as indolent NHL, paraproteinemias, and Castleman disease, as well as non-malignant causes of cytopenias and their management. Heather A. Leitch Jeremy S. Abramson Matthew C. Cheung Lisa K. Hicks

Pathogenesis of bone disorders in HIV infection

Iatrogenic long-term complications of antiretroviral therapy have become a focus of intense research in patients with HIV infection. Antiretroviral therapy has almost normalized the survival of newly infected and drug-adherent individuals, but skeletal complications are of growing concern in the aging population. It has become clear that the prevalence of osteoporosis and related fractures in HIV-infected subjects has increased. Risk factors are multifactorial and include a low body mass index, smoking and possibly viral replication itself and antiretroviral treatment. Treatment with tenofovir in particular may induce osteomalacia in some patients. HIV infection is also complicated by osteonecrosis, which is approximately 100-fold more prevalent than in the general population. Biphosphonates represent the first-line therapy for osteoporosis in HIV-infected patients, but their effects on fractures have not yet been evaluated.

Vertebral fractures in AIDS patients within 6 months from highly active antiretroviral therapy initiation: two case reports

Vertebral fractures in AIDS patients within 6 months from highly active antiretroviral therapy initiation: two case reports

Neuropsychiatric disorders in HIV infection: impact of diagnosis on economic costs of care

HAART is associated with a growing prevalence of HIV-associated neuropsychiatric disorders (NPD) despite improved overall survival. To investigate the added direct costs of medical care for patients with and without NPD. Nine dimensions of patient-specific costs [as costs per patient per month (CPM)] were followed prospectively between 1997 and 2003 in a community-based HIV/AIDS clinic for HIV-1-seropositive patients with a diagnosis of NPD (n = 188) and without (n = 153). Patients with NPD were stratified into subgroups of cognitive impairment (CI), peripheral neuropathies (PN), or other neuropsychiatric disorders (OND). Compared with the non-NPD group ($916), patients in the NPD group showed an increased mean CPM during the 12-month intervals immediately preceding and subsequently following NPD diagnosis [$1371 (P < 0.001) and 1463 US dollars (P < 0.001), respectively], but not at 18 months prior to diagnosis (1061 US dollars; P > 0.05). Intragroup comparisons between 12 month post-diagnosis and 18 month pre-diagnosis showed a mean CPM increased of 67% (1613 US dollars; P < 0.001) with CI, 31% (1490 US dollars; P < 0.01) with PN, and 33% (1362 US dollars; P < 0.01) with OND. Increased numbers of clinic and physician visits, non-antiretroviral drugs and home care accounted for the higher mean CPM (P < 0.05) both pre-and post-diagnosis within the NPD group. Neuropsychiatric disorders in patients with HIV/AIDS increase medical costs both before and after diagnosis, primarily owing to the management of the neuropsychiatric illness. Cost analyses offer useful measures of evolving patient needs, and provide a basis for allocation of healthcare resources.

Reversible ALS-like disorder in HIV infection. An ALS-like syndrome with new HIV infection complete response toantiretroviral therapy

Reversible ALS-like disorder in HIV infection. An ALS-like syndrome with new HIV infection complete response toantiretroviral therapy

Reversible ALS-like disorder in HIV infection.

To describe the clinical features, treatment, and outcome of six cases of HIV-1-associated ALS-like disorder. The authors reviewed patients with HIV infection with neurologic symptoms seen over a 13-year period. Patients were identified by using the El Escorial research diagnostic criteria defining three categories of certainty for definite, probable, or possible ALS. Clinical features, EMG, CSF, serum analyses, and imaging and virological studies were assessed. Six patients with immunodepression (mean CD4(+) cells = 86.2/mm(3); mean age = 34 years) developed distal motor weakness mimicking a monomelic amyotrophy that subacutely progressed regionally or assumed a symmetric distribution on more than one region. EMG was characteristic of motor neuron disease with no multifocal conduction block. Causes other than HIV-1 were ruled out. The unusual rapid extension of the disease and the positive response to antiretroviral therapy suggest that ALS syndrome and HIV infection are etiologically related. HIV-1 might cause an ALS-like disorder by several mechanisms-via neuronal infection, by secretion of toxic viral substance, by inducing the immune system to secrete cytokines, or by inducing an autoimmune disease. These cases suggest that the association between some motor neuron diseases and HIV infection is not coincidental but pathogenetically related and that ALS-like disorder should be considered an HIV-related neurologic complication.