Primary HIV Infection of the Nervous System

Acute aseptic meningitis is a common manifestation in patients with primary neurologic HIV-1 infection (PNHI) and leads to headache and meningismus. Other less common neurologic presentations are with meningoencephalitis, encephalopathy, acute disseminated encephalomyelitis, myelopathy, meningoradiculitis, and peripheral neuropathy, including a Guillain–Barré syndrome. Systemic abnormalities are commonly also present. Laboratory studies may reveal leucopenia, thrombocytopenia, and elevated transaminases. An HIV antibody study may initially be negative even if serum HIV viral load is positive. Once seroconversion occurs, patients are at risk for many neurologic complications.

AIDS dementia complex (ADC) is an important disorder, but its prevalence has declined since highly active antiretroviral therapy (HAART) became available. Affected patients developed a dementia and behavioral disturbances, with a marked change in personality; apathy, inattention, memory disturbances, and language dysfunction are problematic. Motor deficits (slowness, clumsiness, ataxia, weakness) also occur. A primary subacute demyelinating process with a mild cellular response has been found at autopsy. A metabolic/toxic etiology related to the infection has been proposed.

Milder HIV-associated neurocognitive disorders have a high prevalence, even in HIV-positive patients with a long-standing aviremia, but usually do not limit daily activities. HAART itself seems to have little primary neurologic toxicity. Clinically asymptomatic subjects infected with HIV-1 may have abnormal brain MRIs with white matter (demyelination) and gray matter (atrophy) changes.

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