Monday, August 21, 2017

Medicollabowesome: Neurological Diseases in HIV patients

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NEUROLOGICAL DISEASES IN HIV INFECTION

Clinical disease of nervous system accounts for a significant degree of morbidity in a very percentage of patients with HIV infection.

Neurological problems directly attributed to HIV occur through

  • primary or secondary infection
  • inflammatory
  • demyelinating
  • degenerative
These can be classified as:

Opportunistic infections- toxoplamosis, cryptococcosis, CMV, syphilis, MTB, amebiasis
Neoplasm- primary CNS lymphoma, Kaposi sarcoma
HIV-1 infection - aseptic meningitis, AIDS dementia complex
Myelopathy - vascuolar myelopathy, pure sensory ataxia, paresthesia
Peripheral neuropathy - Guillian Barre syndrome, CIDP, mononeuritis multiplex
Myopathy

Pathogenesis:

Damage to the CNS may be direct result of viral infection of the CNS macrophages or glial cells.
It might also be secondary to the release of neurotoxins and potentially toxic cytokines such as IL-1beta, TNF-alpha, IL-6 and TGF-beta.
It has also been reported that HIV-infected individuals with the E4 allele for apo E are at increased risk for AIDS encephalopathy and peripheral neuropathy.

Clinically-

The term HIV-associated neurocognitive disorders (HAND) is used to describe a spectrum of disorders that range from asymptomatic neurocognitive impairement (ANI) to minor neurocognitive disorder (MND) to clinically severe dementia .
The most severe form, HIV-associated dementia (HAD), also referred to as the AIDS dementia complex or HIV encephalopathy, is considered an AIDS-defining illness.


CSF finding-

CSF findings are abnormal in approximately 90% of patients, even during the asymptomatic phase of HIV infection. These abnormalities include-

  • pleocytosis (50-60% of patients)
  • detection of viral RNA (75%)
  • elevated CSF protein (35%)
  • intrathecal synthesis of anti-HIV antibodies (90%)

It is important to point out that evidence of infection of the CNS with HIV does not imply impairment of cognitive function. The neurologic function of an HIV-infected individual should be considered normal unless clinical signs are symptoms suggest ortherwise.



Shivani Mangalgi
Medicowesome 2017




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