Neurologic complications of human immunodeficiency virus (HIV) infection remain common, despite effective antiretroviral treatment (ART). Neurologic manifestations may be due to opportunistic infection, immune reconstitution, or the virus itself, posing diagnostic challenges for the neurologist. Neurologists are also asked to comment on the use of immunomodulatory agents in these patients and to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy or the associated comorbidities.
HIV enters the central nervous system (CNS) soon after infection and can cause atrophy of the brain within 3 months of infection. As patients are living longer, comorbidities such as stroke associated with metabolic syndrome, hepatitis C, and drug abuse are important contributory factors to the neurologic and neuropsychiatric manifestations of HIV infection. Immune-mediated syndromes are increasingly being recognized in patients with HIV infection on antiretroviral therapy. This includes a subacute T-cell–mediated encephalitis called CNS–immune reconstitution inflammatory syndrome, fulminant multiple sclerosis–like lesions, and unmasking of underlying opportunistic infections with profound inflammatory reaction. Our understanding of the most appropriate antiretrovirals for treating or preventing CNS HIV replication continues to improve. Major efforts are being made to understand how the CNS reservoirs are established and maintained, and new approaches are being developed to develop a functional cure or eradicate the virus.
This article reviews the neurologic complications caused by HIV infection, associated comorbidities, or antiretroviral drugs that are commonly encountered by neurologists.
This article was written by Dr Avindra Nath in his personal capacity. The views expressed are his own and do not necessarily represent the views of the National Institutes of Health, the Department of Health and Human Services, or the United States government.
Address correspondence to Dr Avindra Nath, National Institutes of Health, 10 Center Drive, MSC 1430, Building 10/7C103, Bethesda, MD 20892, email@example.com.
Relationship Disclosure: Dr Nath serves on the editorial board of the Journal of Neurovirology and receives research support from the National Institutes of Health.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Nath discusses experimental therapies for neuroprotection in human immunodeficiency virus infection–associated neurocognitive disorders and peripheral neuropathy.