The neurological spectrum of HIV infection

Abstract

Neurological manifestations are frequent in human immunodeficiency virus (HIV)-infected patients and represent a great diagnostic and therapeutic challenge. They may be caused by many different mechanisms: the HIV, opportunistic infections or tumors, autoimmunity, and complications of systemic diseases or drugs, including the antiretrovirals. Patients may suffer several simultaneous neurological diseases, and the HIV and some opportunistic infections may affect simultaneously various levels in the nervous system. Highly active antiretroviral therapy (HAART) has produced a decline in opportunistic diseases and neurological disorders associated with severe immune depression. However, the prolonged survival of patients has increased morbidity due to chronic disorders, such as cerebrovascular disease and HIV-associated neurocognitive disorders. The central nervous system constitutes a reservoir for HIV replication in patients with controlled systemic disease. HAART itself is related to new emerging neurological problems: the specific neurotoxicity of the drugs and the appearance of neurological immune reconstitution inflammatory syndromes.