Chapter 19 Global developments in HIV neurology
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Edwina J. Wright, Kiran T. Thakur, David Bearden, Gretchen L. Birbeck Neurologic conditions associated with HIV remain major contributors to morbidity and mortality, and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence suggests that the central nervous system (CNS) serves as a reservoir for viral replication with major implications for human immunodeficiency virus (HIV) eradication strategies. Though there has been major progress in the last d...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 18 Imaging studies of the HIV-infected brain
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Linda Chang, Dinesh K. Shukla Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or wi...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 17 HIV and spinal cord disease
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Seth N. Levin, Jennifer L. Lyons The epidemiology of spinal cord disease in human immunodeficiency virus (HIV) infection is largely unknown due to a paucity of data since combination antiretroviral therapy (cART). HIV mediates spinal cord injury indirectly, by immune modulation, degeneration, or associated infections and neoplasms. The pathologies vary and range from cytotoxic necrosis to demyelination and vasculitis. Control of HIV determines the differential for all neurologic presentations in infected individuals. Primary HIV-associa...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 16 Neuromuscular complications of HIV infection
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Michelle Kaku, David M. Simpson With the introduction of combination antiretroviral therapy, human immunodeficiency virus (HIV)-infected individuals are living longer, and are commonly confronted with chronic neuromuscular complications. The spectrum of neuromuscular disorders in patients living with HIV infection is wide, and is caused by HIV per se and its products, particular antiretroviral drugs, or a combination of both. The purpose of this chapter is to review peripheral nervous system disorders in the setting of HIV infection, an...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 15 HIV infection and stroke
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Laura Benjamin, Saye Khoo The landscape of human immunodeficiency virus (HIV) infection is changing with the increasing coverage of antiretroviral therapy (ART). Patients are living longer but continually exposed to a virologically suppressed HIV infection. This has resulted in a decrease in acquired immune deficiency syndrome (AIDS)-related complications such as opportunistic infections, and an increase in non-AIDS complications such as stroke. In this era, stroke is perhaps the most important neurologic complication of HIV infection. ...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 14 Primary CNS lymphoma in HIV infection
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Dieta Brandsma, Jacoline E.C. Bromberg Primary CNS lymphoma (PCNSL) has been designated an acquired immune deficiency syndrome (AIDS)-defining disease since 1983 and accounts for up to 15% of non-Hodgkin lymphomas in human immunodeficiency virus (HIV) patients. The majority of HIV patients are Epstein–Barr virus (EBV)-related. The most likely etiology is ineffective immunoregulation of EBV, inducing oncogenic protein expression, and subsequent loss of apoptosis and increased proliferation of lymphocytes. PCNSL generally presents with ...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 13 CNS immune reconstitution inflammatory syndrome
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Lauren Bowen, Avindra Nath, Bryan Smith Immune reconstitution inflammatory syndrome (IRIS) describes a syndrome of aberrant reconstituted immunity, often in association with HIV infection, beginning with a normalization of CD4+ T-cell counts resulting in a dysregulated immune response against an infecting opportunistic pathogen and the host. In this chapter, we discuss the unique nature of IRIS when present in the central nervous system (CNS IRIS) and the changes experienced with each host pathogen and its unique influence on the immun...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 12 Other central nervous system infections: cytomegalovirus, Mycobacterium tuberculosis, and Treponema pallidum
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Christina M. Marra Human immunodeficiency virus (HIV)-infected individuals are particularly susceptible to several central nervous system infections: human cytomegalovirus, which may cause encephalitis, ventriculitis, polyradiculitis, or polyradiculomyelitis; Mycobacterium tuberculosis, which can cause meningitis or space-occupying lesions; and Treponema pallidum subspecies pallidum (T. pallidum), which affects the meninges, cerebrospinal fluid, cranial nerves, and vasculature in early neurosyphilis, and additionally the brain and spinal...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 11 Cryptococcal meningitis in AIDS
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Andrej Spec, William G. Powderly Cryptococcal meningitis remains a significant cause of morbidity and mortality amongst patients living with human immunodeficiency virus (HIV). The prevalence in the developed world has decreased as HIV is being diagnosed earlier, but is still significant, and the prevalence in resource-limited settings is exceedingly high. The presenting symptoms usually include a headache, fever, and, less often, cranial nerve abnormalities. Space-occupying lesions do occur, but are rare. Once diagnosed, patients shoul...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 10 Progressive multifocal leukoencephalopathy
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Shaun Zhai, Bruce James Brew Progressive multifocal leukoencephalopathy (PML) is a relatively common complication of HIV disease. In this chapter changes to the epidemiology are discussed along with an update in its pathogenesis and treatment. Immune reconstitution inflammatory syndrome is increasingly frequent in PML; accordingly management strategies and prognosis are detailed. (Source: Handbook of Clinical Neurology)
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 9 Central nervous system infection with Toxoplasma gondii
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Christina M. Marra Central nervous system infection by Toxoplasma gondii, or Toxoplasma encephalitis, is the most common cause of brain mass lesions in human immunodeficiency virus (HIV)-infected patients. It usually presents as one or more brain abscesses, but it can also cause a diffuse encephalitis or ventriculitis. Individuals who are Toxoplasma immunoglobulin G-seropositive, who have peripheral blood CD4+ T-cell concentrations below 200/μL, are not on antiretroviral therapy, and are not taking trimethoprim-sulfamethoxazole to preve...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 8 NeuroAIDS in children
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Jo M. Wilmshurst, Charles K. Hammond, Kirsty Donald, Jacqueline Hoare, Karen Cohen, Brian Eley The human immunodeficiency virus-1 (HIV-1) enters the central nervous system compartment within the first few weeks of systemic HIV infection and may cause a spectrum of neurologic complications. Without combination antiretroviral therapy (cART), 50–90% of all HIV-infected infants and children develop some form of neuroAIDS. Of the estimated 2.3 million children less than 15 years of age who were living in sub-Saharan Africa at the end o...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 7 HIV-associated neurocognitive disorder
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Ruaridh Cameron Smail, Bruce James Brew Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) affects roughly half the HIV-positive population. The symptoms of cognitive slowing, poor concentration, and memory problems can impact on everyday life. Its diagnosis is validated where possible by identifying deficits in two cognitive domains on neuropsychologic testing in patients either with or without symptoms. Corroborating evidence may be found on imaging, blood tests, and cerebrospinal fluid analysis, though sensi...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 6 Neurologic sequelae of primary HIV infection
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Bruce James Brew, Justin Y. Garber Primary human immunodeficiency virus type 1 (HIV-1) infection is defined as the period from initial infection with HIV to complete seroconversion. Neurologic sequelae of primary HIV-1 infection are not uncommon, potentially affecting all parts of the nervous system. It is important for the neurologist to be aware of symptomatic primary HIV infection, as it may afford an early and accurate diagnosis of HIV infection and the opportunity for consideration of early antiretroviral therapy. This chapter intr...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
Chapter 5 Neuropharmacology
Publication date: 2018 Source:Handbook of Clinical Neurology, Volume 152 Author(s): Alan Winston, Hadi Manji With virologically suppressive antiretroviral therapy, immune system recovery is now achievable for persons living with HIV (PLWH). This immune recovery is associated with dramatic reductions in acquired immune deficiency syndrome (AIDS) defining illnesses including HIV dementia. However, milder form of cognitive disturbances are widely reported in PLWH despite effective antiretroviral therapy. The underlying pathogenic mechanisms of these cognitive disturbances remain elusive, with many potential pathogenic mec...
Source: Handbook of Clinical Neurology - March 29, 2018 Category: Neurology Source Type: research
