Neurological Complications of HIV
Original Editor - Cindy John-Chu
Top Contributors - Cindy John-Chu, Melissa Coetsee, Kim Jackson and Nupur Smit Shah
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]
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:
- 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]
- Opportunistic infections
- Associated diseases: such as specific cancers that are associated with HIV infectio
- 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]
- CMV virus
- Herpes
- Progressive multifocal leukoencephalopathy (PML)
[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]
- ↑ 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).
- ↑ 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).
- ↑ Med School Made Easy. How HIV Infects Cells: an Introduction. Available from: https://www.youtube.com/watch?v=40sCHrOZ9zQ [last accessed 19/9/2020]
- ↑ 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)
- ↑ 5.0 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)
- ↑ 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.
