Bruce J. Brew Immunology/HIV/Infectious Diseases Clinical Services Unit and Department of Neurology, St Vincent’s Hospital, Sydney NSW Zachary J. Webb-Harvey Immunology/HIV/Infectious Diseases Clinical Services Unit, St Vincent’s Hospital, Sydney NSW When evaluating neurological presentations in context of HIV (Human immunodeficiency virus) the differential diagnosis is determined by the stage of HIV infection, previous treatment history, …
Bruce J. Brew Immunology/HIV/Infectious Diseases Clinical Services Unit and Department of Neurology, St Vincent’s Hospital, Sydney NSW Zachary J. Webb-Harvey Immunology/HIV/Infectious Diseases Clinical Services Unit, St Vincent’s Hospital, Sydney NSW Neurological complications of HIV (Human immunodeficiency virus) continue to commonly impact people living with HIV (PLWH) in the post combined antiretroviral therapy (cART) era. The …
HIV associated neurocognitive disorder HIV associated neurocognitive disorder (HAND) represents a significant burden upon PLWH in the post cART era. In a metanalysis of 35,513 PLWH, HAND is reported at a prevalence of 42.6% (1), though it is less common in those with sustained viral suppression and early institution of cART. HAND adversely impacts PWLH …
Since the advent of cART CNS opportunistic infections have significantly declined, however they continue to cause significant morbidity and mortality in PLWH especially in those unaware of their HIV status (54). A recent multicentre retrospective analysis of patients presenting with encephalitis demonstrated a one-year mortality of 31.3% in PLWH compared to 16.0% in HIV negative …
PCNSL is a rare malignancy that affects the brain, leptomeninges, spinal cord or orbits. It is greatly increased in the PWLH compared to the general population, especially with CD4 < 100 cm/mm3 and is considered an AIDS defining illness. Overall incidence has reduced substantially in the post cART era however, unlike other HIV-associated lymphomas, PCNSL …
Prevalence of spinal cord disease in PLWH is largely unknown in the post cART era due to paucity of data. Historical postmortem analysis demonstrated spinal cord disease in at least 50% of patients with acquired immunodefiency syndrome (AIDS) (61). HIV associated spinal cord disorders are mediated indirectly by inflammatory modulation, degeneration, or predisposition to opportunistic …
Acute primary HIV TM is mediated by immune dysregulation from HIV virion CNS penetration and occurs with primary infection and seroconversion (61). Classical features include back pain, urinary retention, lower extremity paraesthesia, spastic paraparesis, a band-like sensory level, hyperreflexia, and abnormal plantar responses in addition to constitutional signs of primary HIV or seroconversion (fevers, malaise, …
HIV associated VM is a well described complication of AIDS with a historical prevalence estimated between 7 – 55% (61). Current epidemiology is unknown but it is uncommon in the post cART era. VM is characterised by white matter spinal cord vacuolisation. Pathologically VM closely resembles subacute combined spinal cord degeneration and is associated with …
HIV-associated sensory neuropathy HIV-associated sensory neuropathy (HIV-SN) is a complication of HIV infection and antiretroviral therapy and continues to impact 38 – 57% of PLWH in the post cART era (61). The proposed pathogenesis of HIV-SN involves primarily dorsal root ganglion infection/inflammation with mononuclear cellular infiltration, increased cytokine expression, and direct neurotoxic effects of viral …
HIV-associated diseases of the peripheral nervous system Read More »
Acute demyelinating polyneuropathy (AIDP), which closely resembles Guillain-Barré syndrome (GBS) is a rare but well recognised disease in PLWH. The pathogenesis of HIV associated AIDP is unknown. Proposed mechanisms include cell-mediated macrophage demyelination, perivascular T cell lymphocytic infiltration, antibody mediated neuronal damage secondary to molecular mimicry, and HIV neurotoxic proteins (75). AIDP most commonly occurs …
Acute and chronic inflammatory demyelinating polyneuropathy Read More »
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