Recent study results below.
George M. Carter
**
Nonopportunistic Neurologic Manifestations of the Human
Immunodeficiency Virus: An Indian Study
Posted 10/04/2005
Alaka K. Deshpande, MD; Mrinal M. Patnaik, MD
Abstract
Context
HIV-1 is a neurotropic virus. In a resource-limited country such as
India, large populations of affected patients now have access to
adequate chemoprophylaxis for opportunistic infections (OIs),
allowing them to live longer. Unfortunately the poor availability of
highly active antiretroviral therapy (HAART) has allowed viral
replication to proceed unchecked. This has resulted in an increase
in the debilitating neurologic manifestations directly mediated by
the virus.
Objective
The main objective of this study was to identify and describe in
detail the direct neurologic manifestations of HIV-1 in
antiretroviral treatment (ART)-naive, HIV-infected patients
(excluding the neurologic manifestations produced by opportunistic
pathogens).
Design
Three hundred successive cases of HIV-1 infected, ART-naive patients
with neurologic manifestations were studied over a 3-year period.
Each case was studied in detail to identify and then exclude
manifestations due to opportunistic pathogens. The remaining cases
were then analyzed specially in regard to their occurrence and the
degree of immune suppression (CD4+ cell counts).
Setting and Patients
The study was carried out in an apex, tertiary, referral care center
for HIV/AIDS in India. All patients were admitted for a detailed
Analysis.
No interventions were carried out, as this was an observational
study.
Results
Of the 300 cases, 67 (22.3%) had neurologic manifestations due to
the direct effects of HIV-1. The HIV infection involved the
neuroaxis at all levels. The distribution of cases showed that the
region most commonly involved was the brain (50.7%). The
manifestations included stroke syndromes (29.8%), demyelinating
illnesses (5.9%), AIDS dementia complex (5.9%), and venous sinus
thrombosis (4.4%). The other manifestations seen were peripheral
neuropathies (35.8% of cases), spinal cord pathologies (5.9% of
cases), radiculopathies (4.4% of cases), and a single case of
myopathy. The onset of occurrence of these diseases and their
progression were then correlated with the CD4+ cell counts.
Conclusions
HIV infection is responsible for a large number of nonopportunistic
neurologic manifestations that occur across a large immune spectrum.
During the early course of the disease, the polyclonal
hypergammaglobulinemia induced by the virus results in demyelinating
diseases of the central- and peripheral nervous systems (CNS and
PNS). As the HIV infection progresses, the direct toxic effects of
the virus unfold, directly damaging the CNS and PNS, resulting in
protean clinical manifestations.
Alaka K. Deshpande, MD, Professor and Head, Department of Retroviral
Medicine, Grant Medical College & Sir JJ Group of Hospitals, Mumbai,
India.
Email: alakadeshpa…@rediffmail.com.
Mrinal M. Patnaik, MD, Chief Resident, Department of Retroviral
Medicine, Grant Medical College & Sir JJ Group of Hospitals, Mumbai,
India
Disclosure: Alaka K. Deshpande, MD, has disclosed no relevant
financial relationships.
Disclosure: Mrinal M. Patnaik, MD, has disclosed no relevant
financial relationships.
Medscape General Medicine. 2005;7(3) ©2005 Medscape
http://www.medscape.com/viewarticle/511865