Neurologic manifestations of HIV infection

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Centers for Disease Control and Prevention reports; recent communications and abstracts; and authors' published and unpublished data.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.