Neurological Complications of AIDS Fact Sheet

What is AIDS?
AIDS (acquired immune deficiency syndrome) is a condition that occurs in the most advanced stages of human immunodeficiency virus (HIV) infection.  It may take many years for AIDS to develop following the initial HIV infection.
Although AIDS is primarily an immune system disorder, it also affects the nervous system and can lead to a wide range of severe neurological disorders.
How does AIDS affect the nervous system?
The virus does not appear to directly invade nerve cells but it jeopardizes their health and function.  The resulting inflammation may damage the brain and spinal cord and cause symptoms such as confusion and forgetfulness, behavioral changes, severe headaches, progressive weakness, loss of sensation in the arms and legs, and stroke.  Cognitive motor impairment or damage to the peripheral nerves is also common.  Research has shown that the HIV infection can significantly alter the size of certain brain structures involved in learning and information processing.
Other nervous system complications that occur as a result of the disease or the drugs used to treat it include pain, seizures, shingles, spinal cord problems, lack of coordination, difficult or painful swallowing, anxiety disorder, depression, fever, vision loss, gait disorders, destruction of brain tissue, and coma.  These symptoms may be mild in the early stages of AIDS but can become progressively severe.
In the United States , neurological complications are seen in more than 40 percent of adult patients with AIDS.  They can occur at any age but tend to progress more rapidly in children.  Nervous system complications in children may include developmental delays, loss of previously achieved milestones, brain lesions, nerve pain, smaller than normal skull size, slow growth, eye problems, and recurring bacterial infections
How are these disorders treated?
No single treatment can cure the neurological complications of AIDS.  Some disorders require aggressive therapy while others are treated symptomatically.
Neuropathic pain is often difficult to control.  Medicines range from analgesics sold over the counter to antiepileptic drugs, opiates, and some classes of antidepressants.  Inflamed tissue can press on nerves, causing pain.  Inflammatory and autoimmune conditions leading to neuropathy may be treated with corticosteroids, and procedures such as plasmapheresis (or plasma exchange) can clear the blood of harmful substances that cause inflammation.
Treatment options for AIDS- and HIV-related neuropsychiatric or psychotic disorders include antidepressants and anticonvulsants.  Psychostimulants may also improve depressive symptoms and combat lethargy.  Antidementia drugs may relieve confusion and slow mental decline, and benzodiazepines may be prescribed to treat anxiety.  Psychotherapy may also help some patients.
Aggressive antiretroviral therapy is used to treat AIDS dementia complex, vacuolar myopathy, progressive multifocal leukoencephalopathy, and cytomegalovirus encephalitis.  HAART, or highly active antiretroviral therapy, combines at least three drugs to reduce the amount of virus circulating in the blood and may also delay the start of some infections.
Other neuro-AIDS treatment options include physical therapy and rehabilitation, radiation therapy and/or chemotherapy to kill or shrink cancerous brain tumors that may be caused by the HIV virus, antifungal or antimalarial drugs to combat certain bacterial infections associated with the disorder, and penicillin to treat neurosyphilis.

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