HIV-associated central nervous system (CNS) conditions include:
Cryptococcal Meningitis:
- Common in patients with CD4 counts <100 cells/µL.
- Symptoms: Headache, fever, photophobia, altered mental status. Concomitant pneumonia and skin rash might be present.
- Diagnosis: CSF analysis showing elevated opening pressure, India ink stain, cryptococcal antigen test. Low CSF WBCs is poor prognostic finding.
- Treatment: Amphotericin B and flucytosine, followed by fluconazole. Perform serial lumbar punctures to reduce ICP is symptomatic.
Toxoplasmosis:
- Common in patients with CD4 counts <100 cells/µL.
- Symptoms: Headache, confusion, focal motor weakness, fever, seizure.
- Diagnosis: MRI showing multiple ring-enhancing lesions, positive Toxoplasma IgG.
- Treatment: Pyrimethamine, sulfadiazine, and leucovorin.
Progressive Multifocal Leukoencephalopathy (PML):
- Caused by JC virus reactivation.
- Common in patients with CD4 counts <50 cells/µL.
- Symptoms: Progressive focal neurological deficits including vision and speech, cognitive impairment.
- Diagnosis: MRI showing non-enhancing white matter lesions, JC virus PCR in CSF.
- Treatment: No specific antiviral treatment; focus on antiretroviral therapy (ART) to improve immune function.
HIV-Associated Neurocognitive Disorders (HAND):
- Spectrum includes asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia.
- Symptoms: Cognitive decline, motor dysfunction, behavioral changes.
- Diagnosis: Neuropsychological testing, exclusion of other causes.
- Treatment: Optimizing ART, supportive care.
CNS Lymphoma:
- Often associated with Epstein-Barr virus (EBV).
- Common in patients with CD4 counts <100 cells/µL.
- Symptoms: Focal neurological deficits, seizures, altered mental status.
- Diagnosis: MRI showing single or multiple enhancing lesions, EBV PCR in CSF. Brain biopsy or SPECT might be helpful.
- Treatment: High-dose methotrexate, ART.
Tuberculous Meningitis:
- Symptoms: Subacute meningitis with headache, fever, cranial nerve palsies.
- Diagnosis: CSF analysis showing lymphocytic pleocytosis, elevated protein, low glucose, positive acid-fast bacilli stain or culture.
- Treatment: Anti-tuberculosis therapy, corticosteroids.
For more information about HIV-AIDS we chose this book.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services. Please refer to your doctor for medical advice.