While it is clear that the CNS may be exposed to HIV early in the course of infection, this does not characteristically result in clinically evident neurological dysfunction until much later. Thus, studies of asymptomatic seropositives have shown that the CSF is frequently mildly abnormal (elevated white blood cells and protein, locally produced antibody, and, in up to 30%, detectable virus), yet the study subjects remained clinically normal even when evaluated using careful quantitative neuropsychological testing. Additionally, prospective studies (including the Multicenter AIDS Cohort Study) have shown that systemically asymptomatic subjects remain neurologically intact. Nonetheless, HIV does cause symptomatic neurological disease later in HIV infecfion, although the mechanisms involved remain uncertain. Very early in the course of HIV infection, at or near the time of seroconversion, some patients develop acute encephalitis, aseptic (nonbacterial) meningitis, or various neuropathies. These unusual syndromes appear to relate either to direct viral infection of the nervous system or to host immune responses (immunopathology triggered by the virus). They are generafly self-limiting and usually resolve with little or no residual effect.
HIV-infected individuals may develop aseptic meningitis at the time of seroconversions or after, which is presumed to be caused by HIV itself. Presenting symptoms are headache and stiff neck, and the diagnosis is made by spinal tap and examination of the CSF that reveal an increased number of cells but negative cultures for bacteria and absence of cryptococcus. This generally benign condition must be differentiated from more important causes of headache (such as toxoplasmosis) or CSF cell abnonnality (such as cryptococcal meningitis)..It also should be differentiated from the more common headache that complicates and is common in HIV infection. Such headache may be severe and persistent, yet no cause is established after thorough evaluation. Some patients appear to respond to low doses of the antidepressant amitriptyline, while others may require the use of narcotic analgesics.
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REFERENCES:
Wolters P et al. The effects of dideoxyinosine (ddI) on the cognitive functioning of children with HIV infection after 6 and 10 months of treatment. VII Intl Conf AIDS, Florence. Vol 2: 194(W.B. 2051), 1991.
Yachoan R et al. Long term toxicity/activity profile of 2Õ,3Õ-dideoxyinosine in AIDS or AIDS-related complex. Lancet 336: 526-29, 1990.
Brouwers P et al. Effect of continuous-infusion zidovudine therapy on neuropsychologic functioning in children with symptomatic human immunodeficiency virus infection. J Pediatr 117: 980-5, 1990.
De Girolami U et al. Neuropathology of the acquired immunodeficiency syndrome. Arch Pathol Lab Med 114: 643-655, 1990.
Gabuzda DH. Neurologic disorders associated with HIV infections. J Am Acad Dermatol 22: 1232-6, 1990.
Heyes, M P et al. Quinolinic acid in cerebrospinal fluid and serum in HIV-1 infecfion:
Relationship to clinical and neurological status. Ann Neurol 29(2): 202-9, Feb. 1991.
Ingraham L et al. Neuropsychological effects of early HIV-1 infection: assessment and methodology. J Neuropsych & Clin Neurosci 2: 174-182, 1990.
Kramer E et al. Brain imaging in acquired immunodeficiency syndrome dementia complex. Sem Nuc Med 20(4): 353-63, 1990.
Lechtenberg R. AIDS in thee brain. Intl J STD & AIDS 1: 311-317, 1990.
Lipton S. Models of neuronal injury in AIDS: another role for the NMDA receptor? Trends in Neurosci, 15(3): 75-79, 1992.
Maj M. Organic mental disorders in HIV-1 infection. AIDS 4: 831-840, 1990.
McArthur J. Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV-1-infected individuals: Results from the Multicenter AIDS Cohort Study. Ann Neurol 26: 601-611, 1989.
McArthur J. Neurologic manifestations of AIDS. Medicine (66) 6: 407-437, 1987.
McGrail M et al. Peptide T studies: Neurophysiologic results. VII Ind Conf AIDS, Florence. Vol 1:194(M.B. 2049), 1991.
Mclntyre K et al. Pilot study of zidovudine (AZT) and zalcitabine (ddC) combination in HIV-associated dementia. Abstact #PBO 233, X Intl Conf AIDS, Yokohama, 1994.
Perdices M et al. Neuropsychological investigation of patients with AIDS and ARC.
J AIDS 3: 555-564, 1990.
Perry S. Organic mental disorders caused by HIV: update on early diagnosis and treatment. Am J Psych 147(6): 696-710, 1990.
Portegies P. Declining incidence of AIDS dementia complex after introduction of zidovudine treatment. B Med J 299(6703): 819-21, 1989.
Price R et al. The brain in AIDS: Central nervous system HIV-1 infection and the AIDS dementia complex. Science 239: 586-92, 1988.
Price R et al. Central and peripheral nervous system complications of HIV-1 infecfion and AIDS. In: AIDS, Etiology, Diagnosis, Treatment and Prevention, eds. DeVita VT Hellman S and Rosenberg SA. J.B. Lippincott Company, Philadelphia, 3rd ed. 14:237-257, 1992.
Pullian L et al. Human immunodeficiency virus-infected macrophages produce soluble factors that cause histological and neurochemical alterations in cultured human brains. J Clin Invest 87(2): 503-12, Feb. 1991.
Satriano, J et al. Central nervous system stimulants as symptomatic treatment for AIDS dementia commplex. VII Intl Conf AIDS, Florence. Vol 1: 195 (M.B. 2053),1991.
Sidtis et al. Zidovudine treatment of the AIDS dementia complex: Results of a placebo-controlled trial. Ann Neur 1993.
Simpson DM et al. Neurologic Manifestations of HIV Infection. Ann Intem Med 121: 769-785,1994.
Stover E et al. CNS effects of HIV-1 infecfion and AIDS in infants and children: A collaborative research agenda. Ped AIDS and HIV Infection 1: 109-119, Nov. 6, 1990.
Wiley C et al. Human immunodeficiency virus: infection of the nervous system. Curr Topics Microbiol 160: 157-72, 1990.
Worley IM et al. Clinical manifestations of the HIV-1 infection of the nervous system. In: Handbook of Neurovirology, W Stroop and R McKendall, eds. Marcel Dekker, 1992.
Worley JM et al. Management of neurologic complications of HIV-1 infection. In: The Medical Mmagement of AIDS, M Sande md P Volberding, eds. Philadelphia: W.B. Saunders Co., third edition. 13:193-217,1992.
Tozzi V et al. Effects of zidovudine in 30 patients with mild to end-stage AIDS dementia complex. AIDS 7: 683-92, 1993.
OTHER REPORTS:
Aronow H et al. The management of the neurological complications of HIV infection and AIDS. AIDS 2(suppl 1): S 151-9, 1988.
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