Monday, 23 December 2013

CNS complications in HIV infection (AIDS)

Neurologic complications occur in more than 40% of patients with HIV infection. They are the presenting features of AIDS in 10-20% of cases.1
The access to the AIDS treatment has improved leading to decreased mortality in last decade but the spread of infection is still high.

Types of CNS complications 
Brain may be affected by a variety of abnormalities in association with HIV infection. . Opportunistic infections depend upon the clinical stage of the disease, viral load and CD4+ Lymphocyte count.

AIDS patients are more prone for vasculitis causing stroke leading to Transient Ischemic Attack ( TIA) , infarct and hemorrhages in brain and  vascular myelopathy.

HIV- associated neurocognitive disorder

HIV encephalitis also called AIDS- dementia complex ( ADC ) , is a progressive subcortical dementia.

CNS Lymphoma

Progressive Multifocal Leukoencephalopathy ( PML)

Fungal Infections ( e.g. Cryptococcal meningitis)

Tubercular meningitis,  Toxoplasmosis, Neurocysticercosis, Cytomegalovirus ( CMV) encephalitis

Kaposi Sarcoma , Peripheral neuropathies

DIAGNOSIS
To diagnose CNS involvement in AIDS , CT scan or MRI with contrast with MR spectroscopy is very useful tool . Other investigations like CSF study and stereotactic biopsy are needed depending upon the type of involvement.

Sources:
Medscape http://www.emedicineheath.com
http://www.dirjournal.org/pdf ( Diag Interv Radiol 2010; 16:193-200)
RED
http://en.wikipedia.org/wiki/HIV/AIDS
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