Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
THE NERVOUS SYSTEM: PATHOPHYSIOLOGY AND CLINICAL MANIFESTATIONS
The Epidemiology of AIDS: Expression, Occurrence, and Control of Human Immunodeficiency Virus Type 1 Infection. Kaslow RA and Francis DP, eds. New York, Oxford University Press, p. 68-83, 1989.. Unique Identifier : AIDSLINE ICDB/90668112 Brew B; Sidtis JJ; Price R; Dept. of Neurology, Memorial Sloan-Kettering Cancer Center, New; York, NY 10021
Abstract:
The course of infection by HIV-1 commonly is complicated by both CNS and peripheral nervous system (PNS) disorders that contribute importantly to its morbidity. The commonest and clinically most important of these disorders are reviewed. Topics include CNS disorders known or suspected to relate to direct HIV-1 infection of the CNS (early symptomatic infection, asymptomatic infection, aseptic meningitis, and AIDS dementia complex); opportunistic infections (toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, cytomegalovirus encephalitis, miscellaneous herpesvirus infections, mycobacterial infections); opportunistic neoplasms (primary CNS lymphoma and metastatic lymphoma); and peripheral neuropathies and myopathies complicating HIV-1 infection (eg, mononeuritides, brachial plexopathy, acute demyelinating polyneuropathy (Guillain-Barre), and sensorimotor polyneuropathy). Although several of these neurological disorders were recognized and characterized early in the AIDS epidemic and are now reasonably well understood, others remain to be precisely defined with respect to their etiology, pathogenesis, natural history, and therapy. These aspects are especially pertinent to those conditions known or suspected to relate to direct HIV-1 infection of the CNS or PNS. These disorders warrant rigorous investigation to include (1) collection of background information (degree of immunosuppression, concomitant systemic diseases, and perhaps cofactors); (2) careful neurological diagnosis (involving diagnostic neurological examinations, neuroimaging, and cerebrospinal fluid (CSF) analysis); (3) standardized quantitative neurological and neuropsychological evaluations; and (4) virological analysis (of CSF and blood in life and tissue at autopsy). Tissue culture and animal models need to be developed and exploited for complementary laboratory studies. The AIDS dementia complex and other manifestations of HIV-1 nervous system infection are clinically and biologically important. Additionally, their understanding has implications not only for AIDS, but also for neurological and psychiatric disorders of unknown etiology. (89 Refs)
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/DIAGNOSIS/ *PHYSIOPATHOLOGY AIDS Dementia Complex/PHYSIOPATHOLOGY Human HIV Infections/COMPLICATIONS/DIAGNOSIS/*PHYSIOPATHOLOGY HIV-1/*PATHOGENICITY Nervous System/PHYSIOPATHOLOGY Nervous System Diseases/COMPLICATIONS/DIAGNOSIS/*PHYSIOPATHOLOGY Opportunistic Infections/PHYSIOPATHOLOGY MONOGRAPH REVIEW, TUTORIAL REVIEW 901230
M90C3734
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
