Neurological complications of AIDS

HIV/AIDS
Synonyms	HIV disease, HIV infection
Pronounce	N/A
Field	Infectious disease, immunology
Symptoms	Early: Flu-like illness Later: Large lymph nodes, fever, weight loss
Complications	Opportunistic infections, tumors
Onset
Duration	Lifelong
Types	N/A
Causes	Human immunodeficiency virus (HIV)
Risks	Unprotected anal or vaginal sex, having another sexually transmitted infection, needle sharing, medical procedures involving unsterile cutting or piercing, and experiencing needlestick injury.
Diagnosis	Blood tests
Differential diagnosis
Prevention	Safe sex, needle exchange, male circumcision, pre-exposure prophylaxis, post-exposure prophylaxis
Treatment	Antiretroviral therapy
Medication
Prognosis	Near normal life expectancy with treatment 11 years life expectancy without treatment
Frequency	55.9 million – 100 million total cases 1.7 million new cases (2019) 38 million living with HIV (2019)
Deaths	32.7 million total deaths 690,000 (2019)

AIDS is primarily an immune system disorder caused by the human immunodeficiency virus (HIV), but it can also affect the nervous system. HIV does not appear to directly invade nerve cells but it jeopardizes their health and function, causing symptoms such as confusion, forgetfulness, behavioral changes, headaches, progressive weakness and loss of sensation in the arms and legs, cognitive motor impairment, or damage to the peripheral nerves. Other complications that can occur as a result of HIV infection or the drugs used to treat it include pain, seizures, shingles, spinal cord problems, lack of coordination, difficult or painful swallowing, anxiety disorder, depression, fever, vision loss, gait disorders, destruction of brain tissue, and coma. Other AIDS-related nervous system disorders may be caused by certain cancers or by illnesses that would not otherwise affect people with healthy immune systems.

Neurological complications

Among the most common neurological complications are: AIDS dementia complex, causing symptoms such as encephalitis (inflammation of the brain), behavioral changes, and a gradual decline in cognitive function; central nervous system lymphomas, cancerous tumors that either begin in the brain or result from a cancer that has spread from another site in the body; cryptococcal meningitis; cytomegalovirus infections; herpes virus infections; neuropathy; neurosyphilis; progressive multifocal leukoencephalopathy (PML); and psychological and neuropsychiatric disorders.

Treatment

No single treatment can cure the neurological complications of AIDS. Some disorders require aggressive therapy while others are treated symptomatically.

Medications

Medicines range from analgesics sold over the counter to antiepileptic drugs, opiates, corticosteroids, and some classes of antidepressants. Other treatments include radiation therapy or chemotherapy to kill or shrink cancerous brain tumors that may be caused by HIV, antifungal or antimalarial drugs to combat certain bacterial infections, and penicillin to treat neurosyphilis. Aggressive antiretroviral therapy is used to treat AIDS dementia complex, PML, and cytomegalovirus encephalitis. HAART, or highly active antiretroviral therapy, combines at least three drugs to reduce the amount of virus circulating in the blood and may also delay the start of some infections.

Prognosis

The overall prognosis for individuals with AIDS in recent years has improved significantly because of new drugs and treatments. AIDS clinicians often fail to recognize neurological complications of AIDS. Those who suspect they are having neurological complications should be sure to discuss these with their doctor.