HIV/AIDS (CNS manifestations)

The CNS manifestations of HIV/AIDS (neuroAIDS) occur secondary to a wide range of neurodegenerative, infectious, inflammatory, or neoplastic processes.

Epidemiology

Since the introduction of highly active antiretroviral therapy (HAART) in 1996, there has been a shift in the epidemiology of CNS manifestations of HIV in Western developed countries, with a decline in the incidence of opportunistic infections .

Pathology

HIV/AIDS affects the CNS by one of four mechanisms:

Direct consequences

• HIV-associated neurocognitive disorders (HANDs)
  • HIV-associated dementia with findings appreciable on MRI (previously known as AIDS dementia complex)
• HIV vacuolar myelopathy
• HIV vasculopathy - striking non-atherosclerotic fusiform ectasia of the major intracranial arteries can occur, usually in children with congenital HIV/AIDS. Associated with large hemispheric stroke

Opportunistic infections

• toxoplasmosis (most common)
• cytomegalovirus (CMV)
• fungal infections
  • cryptococcosis
  • candida
  • aspergillus
• tuberculosis
• neurosyphilis
• progressive multifocal leukoencephalopathy (PML)
• bacterial

CNS tumors

• primary CNS lymphoma

Treatment-related complications

• immune reconstitution inflammatory syndrome (IRIS)