Abstract
Human immunodeficiency virus HIV is a retrovirus belonging to the subfamily Lentivirus so-called because of the long latency period between primary infection and subsequent immunological damage in terms of T lymphocyte CD4 depletion leading to acquired immunodeficiency syndrome AIDS. It is estimated that at least one third of patients with HIV infection in the stage of AIDS has at least one sign or symptom of neurological impairment in terms of central, autonomic or peripheral nervous system dysfunction. Nowadays it is well known that most clinical manifestations of neurological dysfunction in the setting of HIV infection are attributable to the role of multiple interactions between the virus and the immune system with further presentation of opportunistic infections and malignancies responsible of a high rate of morbidity and mortality. Here I will discuss some diagnostic and therapeutic guidelines that I recommend for management of main neurological syndromes in context of HIV infection in Colombia.
References
Greene WC. The molecular biology of human immunodeficiency virus type 1 infection. N Engl J Med Jan 31 1991;324:308-17.
Soto Ramirez LE. Physiopathology and treatment of acquired immunodeficiency syndrome. Rev Invest Clin 2000;52:60-71.
O’Brien SJ, Nelson GW. Human genes that limit AIDS.
Nat Genet. 2004;36:565-574.
Telenti A, Bleiber G. Host genetics of HIV-1 susceptibility. Future Virol 2006;1:55-70.
Telenti A. Host polymorphism in post-entry steps of the HIV-1 life cycle and other genetic variants influencing HIV-1 pathogenesis. Curr Opin HIVAIDS 2006;1:232-240.
Alaeus A. Significance of HIV-1 genetic subtypes. Scand J Infect Dis 2000; 32:455-63.
Douek DC, Picker LJ, Koup RA. T cell dynamics in HIV-1 infection. Annu Rev Immunol 2003;21:265-304.
Douek DC, Brenchley JM, Betts MR, et al. HIV preferentially infects HIV-specific CD4+ T cells. Nature 2002;417:95-98.
Grossman Z, Meier-Schellersheim M, Sousa AE, Victorino RM, Paul WE. CD4+ T-cell depletion in HIV infection: are we closer to understanding the cause? Nat Med 2002;8:319-323
Vitkovic L., Tardieu M. Neuropathogenesis of HIV-1 infection. Outstanding questions. C R Acad Sci III 1998;321:1015-21.
Berger JR, Levy RM. Editors. AIDS & the nervous system.Philadelphia: Lippincott - Raven, 2 ed; 1997.
Koenig S, Gendelman HE, Orenstein JM, et al. Detection of AIDS virus in macrophages in brain tissue from AIDS patients with encephalopathy. Science 1986;233:1089-1093.
Orenstein JM, Fox C, Wahl SM. Macrophages as a source of HIV during opportunistic infections. Science 1997;276:1857-1861.
Glass JD, Johnson RT. Human immunodeficiency virus and the brain. Annu Rev Neurosci 1996; 19:1-26.
Gendelman HE, Lipton SA, Epstein L, Swindells
S. Editors (1998). The neurology of AIDS. New York: Chapman & Hall, 1998.
Foudraine NA, Hoetelmans RM, Lange JM, et al. Cerebrospinal-fluid HIV-1 RNA and drug concentrations after treatment with lamivudine plus zidovudine or stavudine. Lancet 1998;351:1547-1551.
Plum F, Posner JB. Diagnosis of stupor and coma. “2nd. Ed.Philadelphia: F.A. Davis Co.,1972.
- Vanhems P, Dassa C, Lambert J, et al. Comprehensive classification of symptoms and signs reported among 218 patients with acute HIV-1 infection. J Acquir Immune Defic Syndr 1999; 21: 99-106.
Colven R, Harrington RD, Spach DH, Cohen CJ, Hooton TM. Retroviral rebound syndrome after cessation of suppressive antiretroviral therapy in three patients with chronic HIV infection. Ann Intern Med 133 (2000),
pp. 430-434.
Paton P, Poly H, Gonnaud P-M, Tardy J-C, Fontana J, Kindbeiter K, et al. Acute meningoradiculitis concomitant with seroconversion to human immunodeficiency virus type
Res Virol 1990; 141: 427-433.
Quinn TC. Grand rounds at the Johns Hopkins Hospital acute primary HIV infection. JAMA 1997; 278: 58-62.
Lindbäck S, Thorstensson R, Karlsson AC, von Sydow M, Flamholc L, Blaxhult A, et al. Diagnosis of primary HIV-1 infection and duration of follow-up after HIV exposure. AIDS 2000; 14: 2333-2339.
Berrey MM, Schacker T, Collier AC, Shea T, Brodie SJ, Mayers D, et al. Treatment of primary human virus type 1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS. J Infect Dis 2001; 183: 1466-1475.
Rosenberg ES, Attfeld M, Poon SH, Phillips MN, Wilkes BM, Eldridge RL, et al. Immune control of HIV-1 after early treatment of acute infection. Nature 2000; 407: 523-526.
DeSimone JA, Pomerantz RJ, Babinchak TJ. Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med 2000; 133:447-454.
Stoll M, Schmidt RE. Immune restoration inflammatory syndromes: the dark side of successful antiretroviral treatment. Curr Infect Dis Rep 2003; 5:266-276.
Stoll M, Schmidt RE. Immune restoration inflammatory syndromes: apparently paradoxical clinical events after the initiation of HAART. Curr HIV/AIDS Rep 2004; 1:122-127.
Dhasmana DJ, Dheda K, Ravn P, Wilkinson RJ, Meintjes G. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy: pathogenesis, clinical manifestations and management.Drugs 2008; 68:191-208.
Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am 2006; 20:507-544.
Garcia-Hermoso D, Janbon G, Dromer F. Epidemiological evidence for dormant Cryptococcus neoformans infection. J Clin Microbiol 1999; 37:3204-3209.
Feldmesser M, Harris C, Reichberg S, Khan S, Casadevall A. Serum cryptococcal antigen in patients with AIDS. Clin Infect Dis 1996; 23:827-830.
Van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, et al. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med 1997; 337:15-21.
Saag MS, Graybill RJ, Larsen RA, Pappas PG, Perfect JR, Powderly WG, et al. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:710-718.
Denning DW, Armstrong RW, Lewis BH, Stevens DA, et al. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am J Med 1991; 91:267-272.
Bach MC, Tally PW, Godofsky EW. Use of cerebrospinal fluid shunts in patients having acquired immunodeficiency syndrome with cryptococcal meningitis and uncontrollable intracranial hypertension. Neurosurgery 1997; 41:1280-1282; [Discussion 1282-1283.]
Fessler RD, Sobel J, Guyot L, Crane L, Vazquez J, Szuba MJ, et al. Management of elevated intracranial pressure in patients with cryptococcal meningitis. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17:137-142.
Pfaller MA, Messer SA, Hollis RJ, Jones RN. In vitro activities of posaconazole (Sch 56592) compared with those of itraconazole and fluconazole against 3685 clinical isolates of Candida spp. and Cryptococcus neoformans. Antimicrob Agents Chemother 2001; 45:2862-2864.
Pfaller MA, Zhang J, Messer SA, Brandt ME, Hajjeh RA, Jessup CJ, et al. In vitro activities of voriconazole, fluconazole, and itraconazole against 566 clinical isolates of Cryptococcus neoformans from the United States and Africa. Antimicrob Agents Chemother 1999; 43:169-171.
Pappas PG, Bustamante B, Ticona E, Hamill RJ, Johnson PC, Reboli A, et al. Recombinant interferon-gamma 1b as adjunctive therapy for AIDS-related acute cryptococcal meningitis. J Infect Dis 2004; 189:2185-2191.
Pedrol E, Gonzalez-Clemente JM, Gatell JM, et al. Central nervous system toxoplasmosis in AIDS patients : efficacy of an intermittent maintenance therapy. J Acquir Immune Defic Syndr 1990; 4: 511-517
Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 1992:327; 1643-1648
Navia BA, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome. Clinical and Neuropathological changes in 27 patients. Ann Neurol 1986; 9: 224-238.
Venkatachalam S, Balakrishnan C, Mangat G, et al. Central nervous system toxoplasmosis in acquired immuno deficiency syndrome. J Assoc Physicians India 1995; 43: 427-430
Marra MC. Infections of the central nervous system in patients infected with human immunodeficiency virus. Continuum. Lifelong Learning in Neurology. Infectious Diseases.2006; 12:111-32.
Verma A. Neurological manifestations of human immune deficiency virus infection in adults. Neurology in Clinical Practice. 2004;2:1581-1601.
Offiah CE, Turnbull IW. The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clinical Radiology. 2006; 61:393-401.
Montoya JG. Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. J Infect Dis 2002;185:73-82.
Dedicoat M, Livesley N. Management of toxoplasmic encephalitis in HIV-infected adults (with an emphasis on resource-poor settings). Cochrane Database Syst Rev. 2006; 3:CD005420.
Romanelli F, Pomeroy C. Concurrent use of antiretrovirals and anticonvulsants in human immunodeficiency virus (HIV) seropositive patients. Curr Pharm Des. 2003;9:1433-9.
Navia BA, Jordan BD, Price RW. The AIDS dementia complex: I clinical features. Ann Neurol 1986;19:517-24.
Dana Consortium on therapy for HIV dementia and related cognitive disorders. Clinical confirmation of the American Academy of Neurology algorithm for HIV-1 associated cognitive/motor disorder. Neurology 1996;47:1247-53.
Brew BJ, Pemberton L, Cunninghan P, Law MG. Levels of human immunodeficiency virus type 1 RNA in cerebrospinal fluid correlate with AIDS dementia stage. J Infect Dis 1997; 175:963-6.
Tyler K.L, McArthur J.C. Through a glass, darkly: cerebrospinal fluid viral load measurements and the pathogenesis of human immunodeficiency virus infection of the central nervous system. Arch Neurol 2002; 59:909-12.
Sacktor NC, Wong M, Nakasujja N et al. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS 2005; 19:1367-74.
Wojna V, Skolasky RL, McArthur JC, Maldonado E, et al. Spanish validation of the HIV dementia scale in women AIDS Patient Care STDS. 2007 Dec; 21(12):930-41.
Tambussi G, Gori A, Capiluppi B, et al. Neurological symptoms during primary human immunodeficiency virus (HIV) infection correlate with high levels of HIV RNA in cerebrospinal fluid. Clin Infect Dis. 2000 Jun;30(6):962-5.
Power C, Kong PA, Crawford TO, et al. Cerebral white matter changes in Acquired immunodeficiency syndrome dementia: alterations of the blood brain barrier. Ann of Neurol 1993; 34:339-50.
Sacktor NC, Lyles RH, Skolasky RL, et al. Combination antiretroviral therapy improves psychomotor speed performance in HIV-seropositive homossexual men. Multicenter AIDS Cohort Study (MACS). Neurology 1999;52:1640-7.
Robertson KR, Hall CD. Assessment of neuroAIDS in the international setting. J Neuroimmune Pharmacol. 2007; 2:105-11. Epub 2007 Jan 3.
Tan SV, Guiloff RJ. Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry. 1998 Jul;65(1):23-8.
Anneken K, Fischera M, Evers S, Kloska S, Husstedt IW. Recurrent vacuolar myelopathy in HIV infection. J Infect. 2006 Jun;52(6):e181-3. Epub 2005 Nov 7.
Petito CK. Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with the acquired immunodeficiency syndrome. N Engl J Med 1985;312: 874-879.
Authier FJ, Chariot P, Gherardi RK. Skeletal muscle involvement in human immunodeficiency virus (HIV)- infected patients in the era of highly active antiretroviral therapy (HAART). Muscle Nerve. 2005 Sep;32(3):247-60.
Verma S, Micsa E, Estanislao L, Simpson D. Neuromuscular complications in HIV. Curr Neurol Neurosci Rep 2004; 4: 6-67.
Verma A, Bradley WG. HIV-1-Associated Neuropathies. CNS Spectr. 2000 May; 5(5):66-72.
Brew BJ. The peripheral nerve complications of human immunodeficiency virus (HIV) infection. Muscle Nerve 2003; 28.542-552.
LECTURAS RECOMENDADAS
Activación del sistema inmune
- Alexaki A, Liu Y, Wigdahl B. Cellular reservoirs of HIV-1 and their role in viral persistence. Curr HIV Res. 2008;6:388-400.
Aspectos inmunológicos del VIH y el sistema nervioso
- Minagar A, Commins D, Alexander JS, et al. Characteristics and diagnosis of the neurological complications of AIDS. Mol Diagn Ther 2008;12:25-43.
- Anthony IC, Bell JE. The Neuropathology of HIV/AIDS. Int Rev Psychiatry. 2008;20:15-24.
- Kaul M, Lipton SA. Mechanisms of neuroimmunity and neurodegeneration associated with HIV-1 infection and AIDS Neuroimmune Pharmacol. 2006;1:138-51.
- Price RW, Epstein LG, Becker JT, et al. Biomarkers of HIV-1 CNS infection and injury Neurology. 2007;69:1781-8.
- Arendt G, Nolting T, Frisch C, et al .Intrathecal viral replication and cerebral deficits in different stages of human immunodeficiency virus disease. J Neurovirol 2007;13:225-32.
Criptococosis meníngea
- Thakur R, Sarma S, Kushwaha S. Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center. Indian. J Pathol Microbiol. 2008;51:212-4
- Murthy JM. Fungal infections of the central nervous system: The clinical syndromes. Neurol India 2007;55:221-5.
- Kethireddy S, Andes D. CNS pharmacokinetics of antifungal agents. Expert Opin Drug Metab Toxicol 2007;3:573-81.
Toxoplasmosis cerebral
- Smego RA Jr, Orlovic D, Wadula J. An algorithmic approach to intracranial mass lesions in HIV/AIDS. Int J STD AIDS 2006;17:271-6.
- Manzardo C, Del Mar Ortega M, Sued O, García F, Moreno A, Miró JM. Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era. J Neurovirol. 2005;11 Suppl 3:72-82.
Síndrome de deterioro cognoscitivo
- Kipnis J, Derecki NC, Yang C, Scrable H. Immunity and cognition: what do age-related dementia, HIV-dementia and ‘chemo-brain’ have in common? Trends Immunol 2008;29:455-63.
- Liner Ii KJ, Hall CD, Robertson KR. Effects of antiretroviral therapy on cognitive impairment. Curr HIV/AIDS Rep. 2008;5:64-71.
- Collier A, Ghosh S, Dowie A, Walsh K, O’Leary C. HIV testing in dementia: clinical, ethical and patient safety implications. Br J Hosp Med (Lond) 2008;69:500-3.
- Cinque P, Brew BJ, Gisslen M, et al. Cerebrospinal fluid markers in central nervous system HIV infection and AIDS dementia complex. Handb Clin Neurol 2007;85:261-300.
- Robinson-Papp J, Byrd D, Mindt MR, et al. Motor function and human immunodeficiency virus-associated cognitive impairment in a highly active antiretroviral therapy-era cohort. Arch Neurol 2008;65:1096-101.
Síndrome mielopático (mielopatia asociada al VIH)
- Di Rocco A. HIV myelopathy. Handb Clin Neurol
;85:123-8.
- Bizaare M, Dawood H, Moodley A. Vacuolar myelopathy: a case report of functional, clinical, and radiological improvement after highly active antiretroviral therapy Int J Infect Dis 2008;12:442-4.
Síndrome miopático
- Tien-Auh Chan A, Kirton C, Estanislao L, et al. Myopathy in HIV infection Handb Clin Neurol. 2007;85:139-45.
Síndrome neuropático
- Gonzalez-Duarte A, Robinson-Papp J, Simpson DM. Diagnosis and management of HIV-associated neuropathy. Neurol Clin 2008;26:821-32.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
