Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Simpson, D. M.    Tagliati, M.    Related Articles in PubMed    PubMed Citation    PubMed

REVIEW

Neurologic Manifestations of HIV Infection

David M. Simpson and Michele Tagliati

15 November 1994 | Volume 121 Issue 10 | Pages 769-785

Purpose: To review the clinical features, pathogenetic mechanisms, and management of neurologic manifestations of human immunodeficiency virus (HIV) infection.

Data Sources: Studies published from 1983 to 1994 identified by MEDLINE literature search; Centers for Disease Control and Prevention reports; recent communications and abstracts; and authors' published and unpublished data.

Study Selection: We selected studies that described the clinical characteristics of neurologic disorders in the acquired immunodeficiency syndrome (AIDS), basic science studies addressing the mechanisms of direct or indirect neurologic damage in HIV infection, and clinical trials investigating the effects of therapeutic agents on the neurologic complications of AIDS.

Data Extraction: We evaluated information and data on epidemiologic characteristics, clinical manifestations, pathogenetic mechanisms, and therapy for neurologic complications of HIV disease and outlined a practical approach to assess and manage these disorders.

Data Synthesis: In the past decade, basic and clinical studies have provided considerable information about neurologic manifestations of AIDS. Dementia is the most important "primary" neurologic complication of HIV infection. Focal lesions of the central nervous system include cerebral toxoplasmosis, lymphoma, and progressive multifocal leukoencephalopathy. Other opportunistic infections include cytomegalovirus encephalitis, cryptococcal meningitis, and neurosyphilis. Various peripheral neuropathies and myopathies may occur in association with HIV infection or as toxic effects of antiretroviral agents.

Conclusions: The prevalence of neurologic complications associated with HIV disease will increase as more effective therapies allow persons with AIDS to live longer. Early recognition and treatment of these disorders substantially affect patients' quality of life and survival.

Author and Article Information

From The Mount Sinai Medical Center, New York, New York.
Requests for Reprints: David Simpson, MD, Department of Neurology, Box 1052, The Mount Sinai Medical Center, One gustave L. Levy Place, New York, NY 10029.
Acknowledgments: The authors thank Drs. Susan Morgello and David Wolfe for neuropathologic specimens, Dr. Aryeh Stollman for neuroradiologic studies, Dr. Henry Sacks for reviewing the manuscript, and the staff of the Mount Sinai Neuro AIDS Research Center.
Grant Support: In part by grants from the National Institute of Neurological Disorders and Stroke (RO1-NS28630), National Institute of Allergy and Infectious Disease (UO1-A1-27667), and the National Center for Research Resources (5M01 RR00071).

This article has been cited by other articles:

				R. E. Davaro and A. Thirumalai Life-Threatening Complications of HIV Infection J Intensive Care Med, March 1, 2007; 22(2): 73 - 81. [Abstract] [PDF]

				A. Di Rocco, P. Werner, T. Bottiglieri, J. Godbold, M. Liu, M. Tagliati, A. Scarano, and D. Simpson Treatment of AIDS-associated myelopathy with L-methionine: A placebo-controlled study Neurology, October 12, 2004; 63(7): 1270 - 1275. [Abstract] [Full Text] [PDF]

				S Calado, N Canas, M Viana-Baptista, C Ribeiro, and K Mansinho Multiple cranial neuropathy and HIV-2 J. Neurol. Neurosurg. Psychiatry, April 1, 2004; 75(4): 660 - 661. [Full Text]

				H. A. Kwakwa and M. W. Ghobrial Primary Cerebellar Degeneration and HIV Arch Intern Med, June 25, 2001; 161(12): 1555 - 1556. [Full Text] [PDF]

				L. Monno, G. B Zimatore, M. Di Stefano, A. Appice, P. Livrea, and G. Angarano Reduced concentrations of HIV-RNA and TNF-alpha coexist in CSF of AIDS patients with progressive multifocal leukoencephalopathy J. Neurol. Neurosurg. Psychiatry, September 1, 1999; 67(3): 369 - 373. [Abstract] [Full Text]

				J. Chong, A. D. Rocco, M. Tagliati, F. Danisi, D. M. Simpson, and S. W. Atlas MR Findings in AIDS-Associated Myelopathy AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1412 - 1416. [Abstract] [Full Text]

				V. W. Lee, V. Antonacci, S. Tilak, J. D. Fuller, and T. P. Cooley Intracranial Mass Lesions: Sequential Thallium and Gallium Scintigraphy in Patients with AIDS Radiology, May 1, 1999; 211(2): 507 - 512. [Abstract] [Full Text]

				T. Ernst, L. Chang, M. Witt, I. Walot, H. Aronow, M. Leonido-Yee, and E. Singer Progressive Multifocal Leukoencephalopathy and Human Immunodeficiency Virus–associated White Matter Lesions in AIDS: Magnetization Transfer MR Imaging Radiology, February 1, 1999; 210(2): 539 - 543. [Abstract] [Full Text]

				J. C. Shlay, K. Chaloner, M. B. Max, B. Flaws, P. Reichelderfer, D. Wentworth, S. Hillman, B. Brizz, D. L. Cohn, and for the Terry Beirn Community Programs for Clinica Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial JAMA, November 11, 1998; 280(18): 1590 - 1595. [Abstract] [Full Text] [PDF]

				T. Baldeweg, J. Catalan, and B. G Gazzard Risk of HIV dementia and opportunistic brain disease in AIDS and zidovudine therapy J. Neurol. Neurosurg. Psychiatry, July 1, 1998; 65(1): 34 - 41. [Abstract] [Full Text]

				M. Kundu, S. Sharma, A. De Luca, A. Giordano, J. Rappaport, K. Khalili, and S. Amini HIV-1 Tat Elongates the G1 Phase and Indirectly Promotes HIV-1 Gene Expression in Cells of Glial Origin J. Biol. Chem., April 3, 1998; 273(14): 8130 - 8136. [Abstract] [Full Text] [PDF]

				J D Pollard and G A R Young Neurology and the bone marrow J. Neurol. Neurosurg. Psychiatry, December 1, 1997; 63(6): 706 - 717. [Full Text] [PDF]