Neurological Complications of HIV: Difference between revisions

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== Introduction ==
== Introduction ==
The Human Immunodeficiency Virus (HIV) is a virus known to attack cells of the body's immune system thus, causing the body to become prone to opportunistic infections.<ref>HIV.gov. What Are HIV and AIDS? Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids (accessed 17 September, 2020).</ref> [[Human Immunodeficiency Virus (HIV)|HIV]] infection can also lead to neurologic complications as the the virus belongs to a class of viruses ( the lentiviruses) that are known to pose a high risk of developing chronic neurologic diseases in their human hosts.<ref name=":1">McGuire D/ University of California San Francisco. Neurologic Manifestations of HIV: HIV Insite Knowledge Base Chapter June 2003. Available from: https://hivinsite.ucsf.edu/Insite?page=kb-04-01-02 (accessed 17 September, 2020).</ref>  
The Human Immunodeficiency Virus (HIV) is a virus that attacks cells of the body's immune system, leaving those affected prone to opportunistic infections.<ref>HIV.gov. What Are HIV and AIDS? Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids (accessed 17 September, 2020).</ref> [[Human Immunodeficiency Virus (HIV)|HIV]] infection can also lead to various neurological complications as a result of these infections or the virus itself. HIV belongs to a class of viruses (the lentiviruses) that are known increase the risk of developing chronic neurologic diseases in their human hosts.<ref name=":1">McGuire D/ University of California San Francisco. Neurologic Manifestations of HIV: HIV Insite Knowledge Base Chapter June 2003. Available from: https://hivinsite.ucsf.edu/Insite?page=kb-04-01-02 (accessed 17 September, 2020).</ref>  


{{#ev:youtube|40sCHrOZ9zQ}}<ref>Med School Made Easy. How HIV Infects Cells: an Introduction. Available from: https://www.youtube.com/watch?v=40sCHrOZ9zQ [last accessed 19/9/2020]</ref>
{{#ev:youtube|40sCHrOZ9zQ}}<ref>Med School Made Easy. How HIV Infects Cells: an Introduction. Available from: https://www.youtube.com/watch?v=40sCHrOZ9zQ [last accessed 19/9/2020]</ref>
== Aetiology ==
The immunodefeciency virus is able to cause damage to the Central Nervous System (CNS) having crossed through the blood brain barrier. Neurological conditions from HIV infection can occur throughout the various stages of the infection<ref>Modi G, Mochan A and Modi M. Neurological Manifestations of HIV. In: Okware SI (ed.) Advances in HIV and AIDS Control. Rijeka InTech 2018. Available from: https://www.intechopen.com/books/advances-in-hiv-and-aids-control/neurological-manifestations-of-hiv (accessed 18 September, 2020)</ref>. However, they may occur commonly at the clinical stages  III and IV<ref name=":0">Howlett PW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794503/#!po=56.3333 Neurological Disorders in HIV in Africa: A Review]. African Health Sciences. 2019; 19(suppl 2): A Review. African Health Sciences. 2019; 19(suppl2):1953-1977.</ref>. There are three possible mechanisms by which the HIV infection can damage the nervous system. They are through:
# Direct HIV infection
# Opportunistic infections
# Autoimmunity<ref name=":0" />


== Neurologic Presentations of HIV ==
== Epidemiology ==
Neurological disorders consequent of HIV infection include the following:
Neurological complications related to HIV can occur throughout the various stages of the infection, but is more common in the advanced stages - i.e when HIV has progressed to AIDS<ref>Modi G, Mochan A and Modi M. Neurological Manifestations of HIV. In: Okware SI (ed.) Advances in HIV and AIDS Control. Rijeka InTech 2018. Available from: https://www.intechopen.com/books/advances-in-hiv-and-aids-control/neurological-manifestations-of-hiv (accessed 18 September, 2020)</ref>. About 50% of adults who have AIDS suffer from neurological complications.<ref name=":2">Johns Hopkins Medicine. Neurological Complications of HIV. Available from:https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/neurological-complications-of-hiv (accessed 20/10/2023)</ref>
* Spastic paraparesis
 
* Peripheral neuropathies (e.g. Distal symmetric polyneuropathy)
== Pathophysiology ==
* Polyradiculopathy
HIV can result in neurological complications through various mechanisms, including:
* Neuropathy
 
* [[Myelopathy]]
# '''HIV infection itself:''' HIV does not directly attack the cells in the nervous system, but it causes significant inflammation which can cause damage to the central and peripheral nervous system.<ref name=":2" /> 
* Seizures
# '''Opportunistic infections'''
* HIV-associated [[dementia]]
# '''Associated diseases:''' such as specific cancers that are associated with HIV infectio
* [[Stroke]]<ref name=":1" /><ref>Patrick CK. Neurological Complications of HIV Infection. Available from: https://www.aids.gov.hk/pdf/g190htm/19.htm (accessed 18 September, 2020)</ref>
# '''Anti-retroviral medicine'''
The presence of these conditions is largely dependent on the clinical stage of the patient and the degree of underlying immunosuppression<ref name=":0" />
 
== Neurological Conditions ==
HIV is associated with various CNS and PNS complications, including:
{| class="wikitable"
|+
!'''Category'''
!'''Description & Specific Conditions'''
!'''Prevalence'''
|-
|'''''HIV-associated dementia'''''
|Impaired cognitive function and memory loss as a result of advance HIV
|
|-
|'''''Viral infections'''''
|Common opportunistic viral infections that affect the nervous system include Cytomegalovirus (CMV), Herpes virus and  JC Polyomavirus. Each of these can result in unique neurological manifestations
|
|-
|'''''Fungal infections'''''
|Cryptococcal meningitis, caused by a fungus, can lead to inflammation in the central nervous system
|
|-
|'''''Parasitic infections'''''
|Toxoplasma encephalitis can develop as a result of a parasitic infection
|
|-
|'''''Neuropathy'''''
|Damage to peripheral nerves can lead to polyneuropathy, mononeuropathy or inflammatory neuropathy
|
|-
|'''''Vacuolar myelopathy'''''
|HIV itself can lead to tiny holes in the nerve fibres of the spinal cord, resulting in myelopathy
|
|-
|'''''Lymphomas'''''
|Lymphomas (tumours) can develop in the brain of people living with HIV (PLWH)
|
|-
|'''''Neurosyphilis'''''
|Untreated syphilis in a person with HIV can result in neurological damage
|
|-
|'''''Stroke'''''
|
|
|-
|'''''Psychological conditions'''''
|PLWH often suffer from anxiety and/or depression
|
|}
The presence of these conditions is largely dependent on the clinical stage of the patient and the degree of underlying immunosuppression.<ref name=":0">Howlett PW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794503/#!po=56.3333 Neurological Disorders in HIV in Africa: A Review]. African Health Sciences. 2019; 19(suppl 2): A Review. African Health Sciences. 2019; 19(suppl2):1953-1977.</ref>Below we will explore some of the more common neurological complications in more detail.
 
=== Viral infections ===
 
# '''CMV virus'''
# '''Herpes'''
# '''Progressive multifocal leukoencephalopathy (PML)'''
 
==== HIV-related Neuropathy ====
Caused by virus or ARVs
 
'''Polyneuropathy:''' Affects multiple sensory and motor nerves in the distal limbs; numbness and pain in hands and feet, with weakness
 
'''Mononeuropathy:'''  affect one nerve at a time
 
'''Inflammatory neuropathy:''' results in condition similar to Guillain-Barre Syndrome, or isolated nerve pain if only certain nerves are affected
 
=== HAND ===


== Implications for Physiotherapy  ==
== Implications for Physiotherapy  ==

Revision as of 10:08, 20 October 2023

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Original Editor - Cindy John-Chu

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Introduction[edit | edit source]

The Human Immunodeficiency Virus (HIV) is a virus that attacks cells of the body's immune system, leaving those affected prone to opportunistic infections.[1] HIV infection can also lead to various neurological complications as a result of these infections or the virus itself. HIV belongs to a class of viruses (the lentiviruses) that are known increase the risk of developing chronic neurologic diseases in their human hosts.[2]

[3]

Epidemiology[edit | edit source]

Neurological complications related to HIV can occur throughout the various stages of the infection, but is more common in the advanced stages - i.e when HIV has progressed to AIDS[4]. About 50% of adults who have AIDS suffer from neurological complications.[5]

Pathophysiology[edit | edit source]

HIV can result in neurological complications through various mechanisms, including:

  1. HIV infection itself: HIV does not directly attack the cells in the nervous system, but it causes significant inflammation which can cause damage to the central and peripheral nervous system.[5]
  2. Opportunistic infections
  3. Associated diseases: such as specific cancers that are associated with HIV infectio
  4. Anti-retroviral medicine

Neurological Conditions[edit | edit source]

HIV is associated with various CNS and PNS complications, including:

Category Description & Specific Conditions Prevalence
HIV-associated dementia Impaired cognitive function and memory loss as a result of advance HIV
Viral infections Common opportunistic viral infections that affect the nervous system include Cytomegalovirus (CMV), Herpes virus and JC Polyomavirus. Each of these can result in unique neurological manifestations
Fungal infections Cryptococcal meningitis, caused by a fungus, can lead to inflammation in the central nervous system
Parasitic infections Toxoplasma encephalitis can develop as a result of a parasitic infection
Neuropathy Damage to peripheral nerves can lead to polyneuropathy, mononeuropathy or inflammatory neuropathy
Vacuolar myelopathy HIV itself can lead to tiny holes in the nerve fibres of the spinal cord, resulting in myelopathy
Lymphomas Lymphomas (tumours) can develop in the brain of people living with HIV (PLWH)
Neurosyphilis Untreated syphilis in a person with HIV can result in neurological damage
Stroke
Psychological conditions PLWH often suffer from anxiety and/or depression

The presence of these conditions is largely dependent on the clinical stage of the patient and the degree of underlying immunosuppression.[6]Below we will explore some of the more common neurological complications in more detail.

Viral infections[edit | edit source]

  1. CMV virus
  2. Herpes
  3. Progressive multifocal leukoencephalopathy (PML)

HIV-related Neuropathy[edit | edit source]

Caused by virus or ARVs

Polyneuropathy: Affects multiple sensory and motor nerves in the distal limbs; numbness and pain in hands and feet, with weakness

Mononeuropathy: affect one nerve at a time

Inflammatory neuropathy: results in condition similar to Guillain-Barre Syndrome, or isolated nerve pain if only certain nerves are affected

HAND[edit | edit source]

Implications for Physiotherapy[edit | edit source]

The similarities between the nervous system complications of HIV and other neurological conditions call for thorough assessment of patients with neurological disorders to ascertain the underlying cause of their conditions. This would be resourceful to guide future research in these areas.

References[edit | edit source]

  1. ↑ HIV.gov. What Are HIV and AIDS? Available from: https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids (accessed 17 September, 2020).
  2. ↑ McGuire D/ University of California San Francisco. Neurologic Manifestations of HIV: HIV Insite Knowledge Base Chapter June 2003. Available from: https://hivinsite.ucsf.edu/Insite?page=kb-04-01-02 (accessed 17 September, 2020).
  3. ↑ Med School Made Easy. How HIV Infects Cells: an Introduction. Available from: https://www.youtube.com/watch?v=40sCHrOZ9zQ [last accessed 19/9/2020]
  4. ↑ Modi G, Mochan A and Modi M. Neurological Manifestations of HIV. In: Okware SI (ed.) Advances in HIV and AIDS Control. Rijeka InTech 2018. Available from: https://www.intechopen.com/books/advances-in-hiv-and-aids-control/neurological-manifestations-of-hiv (accessed 18 September, 2020)
  5. ↑ 5.0 5.1 Johns Hopkins Medicine. Neurological Complications of HIV. Available from:https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/neurological-complications-of-hiv (accessed 20/10/2023)
  6. ↑ Howlett PW. Neurological Disorders in HIV in Africa: A Review. African Health Sciences. 2019; 19(suppl 2): A Review. African Health Sciences. 2019; 19(suppl2):1953-1977.
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