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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neurological disorders are among the most frequent and devastating complications of HIV infection and AIDS. As patients survive longer with the availability of highly active anti-retrovital therapy, it is likely that the frequency of some of these disorders will increase, since patients will survive long enough to develop them. The central and peripheral nervous system may be affected by numerous primary and secondary complications. These neurological disorders include HIV dementia, primary CNS lymphoma, toxoplasmosis, progressive multifocal leukoencephalopathy, vacuolar myelopathy, peripheral neuropathies, and myopathy. In this review we discuss current thoughts on clinical features, pathogenesis, diagnostic evaluation, treatment and clinical trials in several of these HIV-associated neurologic disorders.
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PMID:HIV rounds at Cornell: selected neurologic complications of HIV disease. 1136 35

The Multicenter AIDS Cohort Study concluded that HIV-related sensory neuropathy and four opportunistic central nervous system diseases showed a significant upward trend in incidence between 1985 and 1992. Early, aggressive treatment is often necessary for neurological conditions, since mortality and irreversible damage rates can be very high for untreated individuals. Six conditions are presented, showing treatment difficulties of both symptoms, and the underlying disease process. These conditions cover opportunistic infections (toxoplasmosis encephalitis, cryptococcal meningitis, and progressive multifocal leukoencephalopathy), malignancy (primary CNS lymphoma), cognitive disorder (AIDS dementia complex), and nerve damage (peripheral neuropathies).
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PMID:Neurologic conditions are difficult to treat. 1136 62

A two-part report discusses palliative care for opportunistic infections and cancers of HIV-infected people, and addresses systemic manifestations. Guidelines are provided for determining when palliation with traditional methods is best achieved, and when continuation of restorative treatments is an appropriate palliative measure. Pneumocystis carinii pneumonia, cryptococcal meningitis, Cytomegalovirus retinitis, and Mycobacterium avium complex palliative care are examined. The HIV-related cancers, Kaposi's sarcoma and primary central nervous system lymphoma, are also examined.
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PMID:Palliative care and HIV, part I: OIs and cancers. 1136 9

Participants in the National AIDS Malignancy Conference grappled with the effect of highly active antiretroviral therapy (HAART) on cancer. HAART has sharply decreased rates of opportunistic infections in a number of studies, but its impact on AIDS is complicated. Kaposi's sarcoma (KS) rates have rapidly declined in the past few years, corresponding to the time that HAART has been the standard of care. However, the effects on non-Hodgkin's lymphoma are mixed. Researchers also report a higher risk of cervical cancer among HIV-positive women. Immune-suppressed populations experience higher rates of cancer than expected, but the correlation between HIV-induced immune suppression and AIDS malignancies is not likely to be worked out soon. Charts show how the rates of HIV-associated KS and primary CNS lymphoma have decreased recently, and show how HHV-8 seropositivity correlates to the number of sexual partners. Researchers are calling for the development of a diagnostic tool similar to Pap smears to identify early cases of anal cancer.
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PMID:Less cancer--or more--with HAART? Or, reflections on a late opus. 1136 31

A Multicenter AIDS Cohort Study (MACS) demonstrates a 50-percent or greater decline in the incidence of HIV-related dementia, toxoplasmosis, cryptococcal meningitis, progressive multifocal leukoencephalopathy (PML), and primary CNS lymphoma since the 1996 introduction of highly active antiretroviral therapy (HAART). Although data on mortality and morbidity trends associated with these diseases are encouraging, people with HIV are still highly vulnerable to these conditions. PML is a terrifying neurological complication which has been resistant to a number of drugs, but cidofovir is currently being studied in an AIDS Clinical Trials Group (ACTG 363) and a European study group; results to date are controversial. Trial results are given for studies of other neurological complications of HIV. The relatively weak link between levels of HIV RNA in the brain and the onset of neurologic diseases suggests that indirect mechanisms may be critical determinants of neurologic damage.
Hopkins HIV Rep 1999 Mar
PMID:Neurology update. 1136 51

People with HIV/AIDS are vulnerable to primary central nervous system lymphoma (PCNSL), a type of brain cancer. Treatment choices are limited, as chemotherapy tends to further weaken the immune system, and radiation does not seem to have a major impact on survival. One promising treatment approach used AZT, Ganciclovir, and IL-2. A five-person clinical trial was conducted using this drug combination, and radiation if necessary. The subjects generally responded well to therapy. However, further research is needed to verify the findings and investigate optimal dosing.
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PMID:New combination for brain cancer. 1136 35

Epstein-Barr virus (EBV) is a ubiquitous gammaherpesvirus that is associated with a variety of malignancies. In vivo infection of B lymphocytes is initially associated with the broad expression of immunodominant viral latency genes and proliferation of infected cells. Ultimately, a viral reservoir is established in resting B cells with restricted expression of viral latency genes and no expression of immunodominant viral genes. Among the tumours associated with EBV that are relevant to a consideration of EBV in HIV-associated malignancies are posttransplant lymphoproliferative disease, Burkitt's lymphoma (BL) and Hodgkin's disease (HD). BL carries whereas EBV in only a minority of cases whereas HD in patients infected with HIV is virtually always EBV-associated. EBV-directed T cell therapies have proven effective in posttransplant lymphomas in bone marrow transplantation patients. In patients with HIV infection, primary central nervous system (CNS) and immunoblastic lymphomas show similarities with posttransplant lymphoproliferative disease. EBV detection studies in cerebrospinal fluid are useful diagnostically in primary CNS lymphoma. T cell therapies may be useful in the treatment of EBV-associated lymphomas. Thus, a better understanding of the relationship between EBV and these tumours will not only help to clarify their pathogenesis, but may facilitate the development of new diagnostic and therapeutic strategies.
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PMID:Epstein-Barr virus associated lymphoproliferations in the AIDS setting. 1142 53

The incidence of non-Hodgkin's lymphoma (NHL) is increased by approximately 100-fold in patients with advanced HIV infection. Clinical presentations may include systemic lymphoma, primary central nervous system (CNS) lymphoma, and primary effusion lymphoma. Systemic lymphoma is the most common presentation, is almost always of intermediate or high-grade histology and B-cell phenotype, and usually involves extranodal sites. The disease is potentially curable with combination chemotherapy used for immunocompetent patients with lymphoma, although cure is achieved in only approximately 10-35% of patients. Primary CNS lymphoma may be difficult to distinguish from cerebral infection. The prognosis is very poor, although approximately 10% of patients selected for therapy may survive beyond 1 year with brain irradiation. Attention to infection prophylaxis and antiretroviral therapy is important. Evidence suggests that highly active antiretroviral therapy (HAART) has resulted in a decreased incidence of lymphoma, and that patients with systemic lymphoma treated in the post-HAART era have a better prognosis.
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PMID:Clinical aspects and management of AIDS-related lymphoma. 1142 61

With the advent of HAART, there has been a decline in the incidence of AIDS-defining illnesses. Despite this decline, we increasingly see patients who present with AIDS-defining illnesses similar to those seen during the early days of the HIV epidemic because patients are having difficulty in tolerating or adhering to their HAART regimens. In general, patients today are different: some are receiving prophylaxis to prevent HIV-related infections and many have experienced a more prolonged duration of immunosuppression resulting from intermittent use of HAART. We present 4 patients with neurologic symptoms and focal brain lesions and review and compare the diagnosis and treatment of toxoplasmic encephalitis with that of primary CNS lymphoma.
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PMID:Toxoplasmic encephalitis and primary lymphoma of the brain--the shift in epidemiology: a case series and review of the literature. 1168 17

Older individuals (>50 years of age) now comprise over 11% of patients with AIDS in the United States. This percentage is expected to continue to grow, due both to the improved longevity of patients prescribed highly active antiretroviral therapy (HAART) and to new infections among older individuals. This review focuses on the neuropsychiatric and neurological conditions that are most likely to be affected by advancing age-HIV-1-associated cognitive-motor disorder, peripheral neuropathy, progressive multifocal leukoencephalopathy, primary CNS lymphoma, and risk for cerebrovascular accident. Age associations with incidence of these disorders and with treatment foci are specified. Implications for future changes in management are discussed.
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PMID:Aging and neuro-AIDS conditions and the changing spectrum of HIV-1-associated morbidity and mortality. 1175 Feb 8


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