Neurologic Complications of Human Immunodeficiency Virus

Marie F. Grill, MD Neuroinfectious Diseases p. 963-991 August 2021, Vol.27, No.4 doi: 10.1212/CON.0000000000001035
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PURPOSE OF REVIEW This article reviews the neurologic complications associated with human immunodeficiency virus (HIV) infection.

RECENT FINDINGS Neurologic complications of HIV may be caused by direct virally mediated pathology, immune-mediated phenomena in response to viral infection, or opportunistic infections secondary to depletion of lymphocytes. These neurologic disorders may be influenced by the degree of immunosuppression (ie, CD4+ T-cell lymphocyte count) and stage of infection (early versus late), as well as use of antiretroviral therapy, and may manifest as a variety of central and peripheral neurologic syndromes, including the more commonly encountered HIV-associated cognitive disorders and length-dependent sensorimotor polyneuropathy, respectively. Immune dysregulation underlies the majority of these neurologic phenomena, as well as other HIV-associated conditions including immune reconstitution inflammatory syndrome (IRIS), CD8 lymphocytosis, and potentially the development of compartmentalized infection within the CSF, also referred to as CSF escape.

SUMMARY This article reviews a spectrum of clinical syndromes and related neuropathologic states associated with HIV infection.

Address correspondence to Dr Marie F. Grill, Mayo Clinic, Department of Neurology, 13400 E Shea Blvd, Scottsdale, AZ 85259, [email protected].

RELATIONSHIP DISCLOSURE: Dr Grill reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Grill discusses the unlabeled/investigational use of neuropathic pain medications (amitriptyline, lamotrigine, lidocaine gel, and topical capsaicin cream) not specifically approved for human immunodeficiency virus (HIV)-associated neuropathy, as well cidofovir, mirtazapine, and pembrolizumab for the treatment of progressive multifocal leukoencephalopathy.

© 2021 American Academy of Neurology.