AIDS and neurological disease

Neurological diseases are common in patients with HIV and may be responsible for intracranial or peripheral neurological manifestations and eye problems (1).

These neurological symptoms can be due to either direct encephalitic effect of HIV or due to local neoplastic lesions and infectious lesions (2).

• focal lesions - commonly caused by Toxoplasma gondii, CMV, herpes simplex virus and lymphomas
• meninigitis – most commonly due to Cryptococcus neoformans and rarely due to tuberculosis or bacterial infections (2)

Neurological diseases may present with the following symptoms and signs:

• headache, neck stiffness or photophobia
• focal neurological signs suggesting intracranial space occupying lesion
• peripheral neuropathy (especially sensory change or loss)
• confusion, memory loss, or disinhibition
• seizures (1).

The neurological complications of HIV are highly dependent on the stage of the infection.

Early on in the natural history of HIV infection the common complications are due to dysregulation of the immune system. Most disease has an autoimmune basis.

In the later stages of HIV infection opportunistic infections and neoplasms account for most neurological disease.

Some neurological disease is directly caused by HIV, notably the AIDS dementia complex.

Throughout the course of HIV infection drugs may cause neurological side-effects.

Reference:

• (1) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2005. HIV in primary care: an essential guide to HIV for GPs, practice nurses and other members of the primary healthcare team
• (2) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2008. HIV for non-HIV specialists, diagnosing the undiagnosed: A practical guide for healthcare professionals secondary care to support improved detection and diagnosis of HIV in the UK