Treatment of Central Nervous System Manifestations of HIV in the Current Era

Semin Neurol 2019; 39: 391-398 DOI: 10.1055/s-0039-1688915Treatment of neurological, neurocognitive, and neuropsychiatric impairment in the setting of human immunodeficiency virus (HIV) infection remains a complex problem, given several possible mechanisms of pathogenesis. The etiology must be determined based on clinical judgment and objective evidence, including cerebrospinal fluid (CSF) data from lumbar puncture and neuroimaging information from magnetic resonance imaging, when available and indicated. Other neuroinfectious etiologies must be ruled out, including central nervous system (CNS) opportunistic infections. HIV replication in the CNS (including CSF escape) should be evaluated for and excluded. If CSF HIV is detected, we recommend a treatment switch to antiretrovirals (ARVs) targeted to address any CSF HIV resistance mutations identified, or empiric treatment intensification using ARVs with high CNS penetration. If CSF HIV is not detected, treatment intensification with CCR5 inhibitors may be considered as an adjunct to reduce neuroinflammation. Finally, the current ARV regimen must be examined for possible neurotoxicity. Efavirenz has been well-recognized for its neuropsychiatric adverse effects and potential for causing sleep disturbances. Similar concerns have recently been raised with integrase inhibitors, especially dolutegravir and raltegravir, although further studies are needed to determine the risks for clinically relevant neuropsychiatric side effects fr...
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research

Related Links:

Authors: Petrossian RA, Dynda D, Delfino K, El-Zawahry A, McVary KT Abstract INTRODUCTION: The role of organized sleep in overall health and quality-of-life (QoL) is critical. Nocturia necessarily disrupts the normal sleep cycle and negatively impacts one's health, work productivity, and QoL. We investigated, for the first time in an exploratory pilot, the effectiveness of mirabegron for improving sleep disturbance and nocturia. MATERIALS AND METHODS: This was a prospective, open-label 12-week trial evaluating the efficacy of mirabegron in 34 men and women with disordered sleep and lower urinary tract symptoms ...
Source: Canadian Journal of Urology - Category: Urology & Nephrology Tags: Can J Urol Source Type: research
The objective of this systematic review and meta-analysis was to assess the relationship between GB therapy dose and duration on sleep quality, daytime somnolence, and intensity of pain in patients with NP. Subgroup comparisons were planned for high- vs low-dose GBs, where 300 mg per day or more of pregabalin was used to classify high-dose therapy. Trial data were segregated by duration less than 6 weeks and 6 weeks or greater. Twenty randomized controlled trials were included. Primary outcome measures included pain-related sleep interference and incidence of daytime somnolence. Secondary outcomes included daily pain score...
Source: Pain - Category: Anesthesiology Tags: Systematic Review and Meta-Analysis Source Type: research
Most studies of diabetic polyneuropathy (DPN) and painful DPN are conducted in persons with longstanding diabetes. This cross-sectional study aimed to estimate the prevalence of DPN and painful DPN, important risk factors, and the association with mental health in recently diagnosed type 2 diabetes. A total of 5514 (82%) patients (median diabetes duration 4.6 years) enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes cohort responded to a detailed questionnaire on neuropathy and pain. A score ≥4 on the MNSI questionnaire determined possible DPN, whereas pain presence in both feet together with a scor...
Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
In this study, mice were subjected to 60 minutes of cerebral ischemia followed by reperfusion. The SR protocol was accomplished by depriving mice of sleep for 20 hours/day for 14 days starting at 14 days post-ischemia. We found that SR increased CD169+ macrophages infiltration into the ischemic brain parenchyma and inhibited neurogenesis and functional recovery. SR decreased CD169+ macrophages infiltration into the choroid plexus (CP) and cerebrospinal fluid (CSF), accompanied by increased expression of Chemokine C-X3-C-Motif Ligand 1 (CX3CL1) and intercellular adhesion molecule (ICAM-1) via IFN-γ/IFN-γR signal...
Source: Neuroscience - Category: Neuroscience Source Type: research
Publication date: Available online 18 February 2020Source: NeuroscienceAuthor(s): Tsuyoshi Otsuka, Hue Thi Le, Akira Kohsaka, Fuyuki Sato, Hayato Ihara, Tomomi Nakao, Masanobu MaedaAbstractDisturbance of the daily cycles in sleep and wakefulness induced by conditions such as shift work and jet lag can increase the risk of affective disorders including anxiety and depression. The way such circadian disorganization disrupts the regulation of mood, however, is not well understood. More specifically, the impact of circadian disorganization on the daily rhythms of the neuronal function that controls mood remains unclear. We the...
Source: Neuroscience - Category: Neuroscience Source Type: research
Conclusion: Bathing with pine-tar is an efficacious and recommendable adjuvant practice for AD patients. Disease improvement is associated with reduction of SA and IgE. PMID: 32066302 [PubMed - as supplied by publisher]
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
Non-pharmacological interventions, such as maintaining good sleep hygiene and a healthy diet, can help improve, resolve or prevent depression.
Source: The Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
The objective of this research article was to assess the trend of hospitalization, epidemiological characteristics and economic burden in the young adult, aged 18–45 years, presenting with atrial fibrillation.MethodsHospitalization data from the National Inpatient Sample between 2005 and 2015 were used to analyze prevalence of risk factors and financial burden in young adults with atrial fibrillation.ResultsFrom 2005 to 2015, a total of 260,080 admissions were included in the study. From 2005 to 2015, there was a decreasing trend of total admissions with atrial fibrillation among the age group of 18–45 years co...
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
Do children of depressed parents exhibit greater parent- and self-reported sleep disturbance compared to those without any parental psychopathology?Journal of Pediatric Psychology
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Psychiatry Journal Article Source Type: news
BEST supplements for sleep: With a staggering 95 percent of people suffering with insomnia reporting low energy levels and over 75 percent of these experiencing poor concentration at work, finding a natural alternative supplement to ensure a good night's rest is crucial for many. According to studies, what is the best supplement to take to help you get some crucial shut eye?
Source: Daily Express - Health - Category: Consumer Health News Source Type: news
More News: Brain | Isentress | Lumbar Puncture | MRI Scan | Neurology | Sleep Disorders | Sleep Medicine | Study