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 …
Culture of the fungal skin or nail scraping may be required if the speciation of the fungus is required for directed antifungal treatment. Erroneous treatment with topical steroids may reduce available scale for scraping (tinea incognito) and biopsy for tissue culture may be required.
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 …
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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 …
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Mononeuritis multiplex is characterised by the acute onset of one or more nerve palsies. The likely underlying cause of mononeuritis multiplex varies at different stages of HIV disease. A relatively benign form of mononeuritis multiplex occurs early in the course of HIV infection, and commonly resolves spontaneously (76,77). In patients with moderate immunosuppression (CD4 count …
1. Wang Y, Liu M, Lu Q, Farrell M, Lappin JM, Shi J, et al. Global prevalence and burden of HIV-associated neurocognitive disorder: A meta-analysis. Neurology. 2020 Nov 10;95(19):E2610–21. 2. Ellis RJ, Marquine MJ, Kaul M, Fields JA, Schlachetzki JCM. Mechanisms underlying HIV-associated cognitive impairment and emerging therapies for its management. Vol. 19, Nature …