Neurological Complications of HIV
HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immune deficiency syndrome). HIV weakens and slowly breaks down the body’s immune system. That leaves you vulnerable to deadly complications from an infection or certain cancers.
As HIV and AIDS battle your immune system, your central nervous system is also affected. HIV and AIDS both cause a number of neurological problems. That's particularly the case if HIV progresses to AIDS, which occurs in the most advanced stages of HIV.
Today, antiretroviral medicines—when taken as directed—help to slow down the progression of HIV. They also help to slow the start of or to lower the risk of AIDS. Controlling HIV can also lower your risk for neurological complications of HIV.
Facts about HIV/AIDS
HIV is a virus that's sexually transmitted. But it can also be passed from mother to baby and person to person by sharing a contaminated needle or through transfusion of contaminated blood. Untreated, the virus will keep on replicating in the body, getting more and more advanced. Advanced HIV becomes AIDS. This often results in a number of neurological problems as the body becomes more damaged.
HIV doesn't seem to take over the cells in your nervous system. But it does cause major inflammation in the body. This inflammation can harm the spinal cord and brain. It can also stop your nerve cells from working the way that they should.
Neurological problems may result not only from damage caused by the virus itself. But they can also happen from other side effects of HIV and AIDS, such as cancers that are tied to these diseases. Some of the drugs used to treat HIV and AIDS can also cause neurological problems while attempting to control the rapid spread of the virus. Certain genetic factors can influence the risk of neurological side effects from HIV medicines.
Neurological problems don't often set in until HIV is advanced, typically when someone has AIDS. About half of adults with AIDS suffer from neurological problems linked to HIV.
Types of neurological complications of HIV
HIV can cause many health problems that affect the nervous system:
Dementia. When HIV becomes very advanced, HIV-associated dementia or AIDS dementia complex can happen. These disorders impair cognitive function. This means that you may have trouble thinking, understanding, and remembering. This type of dementia can be life-threatening. It can often be prevented when antiretroviral medicines are taken the right way.
Viral infections. HIV can raise your risk for several viral infections that strike the nervous system. Cytomegalovirus infections can impair cognitive function and physical control (like the use of legs and arms and bladder control). They can also affect eyesight, hearing, and your respiratory system, causing problems like pneumonia. People with AIDS are also likely to get a herpes virus infection, like shingles and inflammation in the brain and the spinal cord. The condition progressive multifocal leukoencephalopathy (PML) is also caused by a virus. PML is aggressive and dangerous. In some cases, it can be controlled with antiretroviral medicines.
Fungal and parasitic infections. Cryptococcal meningitis is caused by a fungus. It leads to serious inflammation of the spinal cord and brain. A parasite can cause an infection called toxoplasma encephalitis. It often leads to confusion, seizures, and very painful headaches. Both of these infections can be deadly.
Neuropathy. This is most common in people with advanced HIV. The virus causes damage to nerves throughout the body, resulting in major pain or weakness.
Vacuolar myelopathy. This health problem occurs when tiny holes develop in the fibers of the nerves of the spinal cord. It causes trouble walking, particularly as it gets worse. It's common in people with AIDS who aren't getting treatment and also in children with HIV.
Psychological conditions. People with HIV or AIDS often develop anxiety disorders. They may suffer from depression. They may also have hallucinations and major changes in behavior.
Lymphomas. Tumors called lymphomas often strike the brain of people with HIV. They're often related to another virus, like the herpes virus. Lymphomas can be deadly. But good management of HIV can make treating lymphomas more successful.
Neurosyphilis. If an HIV-infected person also has syphilis that goes untreated, it can quickly worsen and harm the nervous system. It can cause the nerve cells to break down. It can lead to eyesight and hearing loss, dementia, and walking problems.
Once HIV starts affecting your immune system, it can cause many symptoms. HIV-related neurological problems may lead to:
Sudden forgetfulness or confusion
Feeling of weakness that keeps getting worse
Changes in behavior
Problems with balance and coordination
Changes in your eyesight
Wide swings in your heart rate or blood pressure
Diarrhea or loss of bladder control
A loss of feeling in your legs or arms
Mental health problems like anxiety and depression
While a blood test can diagnose HIV and AIDS, a number of other tests are needed to look at the different parts of the nervous system and diagnose neurological problems. Tests often include:
An electromyography and nerve conduction study to measure the electrical activity of the muscles and nerves.
Biopsy to analyze a sample of tissues and to help find tumors in the brain or inflammation in the muscles.
Magnetic resonance imaging (MRI), which uses radio waves and strong magnets to image the brain structures. This is the most powerful conventional imaging tool. It can spot brain inflammation, many infections, tumors, strokes, and tissue destruction within the brain and spinal cord.
Sample of cerebrospinal fluid to look for infections, bleeding, or other problems affecting the spinal cord or brain.
CT scan, which uses X-rays to reconstruct a 3-D picture of the brain. This test is faster and less expensive. But it gives less detail than an MRI scan.
Antiretroviral medicines are used to stop HIV from replicating and spreading throughout the body. They are also used to help lower the risk that it will cause damage to the nervous system.
Specific neurological conditions and complications are treated differently. Cancer may be treated with chemotherapy and radiation. Bacterial infections need antibiotics. Certain medicines may help with viral infections or nerve pain. Counseling and medicines, including antidepressants, may be used to handle some of the mental health problems linked to HIV.
Following all of your healthcare provider's recommendations, especially taking all antiretroviral medicines exactly as told, can help control HIV and prevent it from getting worse. Suppressing the virus with medicines can help prevent damage to the body, including nervous system damage and neurological problems.
Living a healthy lifestyle can help you better control HIV and prevent the progression to AIDS. Vital steps in handling HIV are:
Eating a healthy diet
Maintaining a healthy body weight
Practicing safe sex
Not using illicit IV drugs
Following your medicine plan
January 26, 2018
HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis. UpToDate
Hurd, Robert, MD,Sather, Rita, RN