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

Because little was known about the prevalence of neurological complications of human immunodeficiency virus type 1 (HIV-1) infection in Africa, we conducted a cross-sectional study among consecutive admissions to the internal medicine wards of Mama Yemo Hospital in Kinshasa, Zaire. Of the 196 patients studied, 104 (53%) were HIV-1 seropositive, of whom 50 (48%) had stage 3 and 49 (47%) had stage 4 HIV-1 infection according to the provisional WHO staging criteria for HIV infection. Neuropsychiatric abnormalities were present in 43 (41%) of 104 HIV-1-seropositive patients. Of the HIV-1-seropositive patients, 9 (8.7%; 95% confidence interval, 4-16%) were diagnosed as having possible HIV-1-associated dementia complex, 1 (1%) as having possible HIV-1 myelopathy, and 3 (2.7%) as having possible HIV-1-associated minor cognitive/motor disorder. Definitive diagnoses could not be made because there were no facilities for neuroimaging and neuropathology. Meningitis caused by cryptococcus was diagnosed in six (5.6%) and by Mycobacterium avium in two (2%) of the HIV-1 seropositive patients. Acute onset hemiplegia, believed to be due to stroke, was present in four (4%) of the HIV-1-seropositive patients. The prevalence of other central nervous system opportunistic infections and mass lesions, especially toxoplasmic encephalitis, could not be assessed. In this population of Zairian inpatients, the prevalence of neurological complications of HIV-1 infection was similar to that observed in industrialized countries among patients with advanced HIV disease.
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PMID:Neurological complications of HIV-1-seropositive internal medicine inpatients in Kinshasa, Zaire. 131 94

Encephalitis occupies a large part in the neurological complications of HIV infection. It is frequent and in most cases of poor prognosis. Some cases of encephalitis are directly related to HIV while others are caused by an opportunistic infection. Among the former is the acute encephalitis coincident with seroconversion, which is exceptional and spontaneously regressive, and the subacute encephalitis better known as HIV encephalopathy which has a constantly pernicious course ending in subcortical dementia lethal within a few months. Some cases of opportunistic encephalitis are associated with a virus: a Papovavirus is responsible for progressive multifocal leucoencephalopathy where mental deterioration is combined with focal symptoms, both resulting in death in less than 6 months. Cytomegalovirus is responsible for an encephalitis that is frequently found on pathological examination but is usually subclinical. Anecdotic cases of toxoplasmic encephalitis have been reported. Finally, emphasis should be placed on the frequency of encephalitis-associated pathologies with all possible combinations, the most common being HIV encephalitis with another encephalitis and/or focal ou multifocal infectious or tumoral processes.
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PMID:[Encephalopathies in infection by human immunodeficiency virus]. 131 16

Nervous system opportunistic infections are seen in about one fifth of AIDS cases and account for over 40% of the patients with neurological manifestations. Serious infections are seen in severely immunosuppressed patients, usually with CD4 counts of 200 ml-1 or less. The commonest is CMV, which can produce acute encephalitis, sometimes with focal hemisphere or brain-stem signs, dementia, retinitis, optic neuritis and an ascending radiculomyeloencephalitis. Cryptococcal meningitis is the most frequent fungal disease; a high degree of clinical suspicion is required in patients with fever, malaise, headache or seizures. Only CSF cultures are always positive; both serum and CSF cryptococcal antigen tests are highly sensitive and specific. Treatment with amphotericin B and flucytosine is successful in at least 70% of first episodes but side-effects are common. Without maintenance therapy 50% of patients relapse; fluconazole is recommended. Cerebral toxoplasmosis can present with focal cerebral or spinal cord signs but also as a diffuse encephalopathy; negative T. gondii serology is exceptional but positive serum titres are usually unhelpful. Treatment with sulfadiazine, pyrimethamine and folinic acid achieves good results in 90% of the first episodes, but side-effects are common. Appearances on CT scan or MRI may take several weeks to improve. The value of an empirical approach to treatment is well-established; an initial cerebral biopsy is difficult to justify. Without maintenance therapy a relapse rate of 50% can be expected; therapy with sulfadiazine and pyrimethamine may also prevent pneumocystosis. HIV disease appears to increase the likelihood of neurosyphilis, and the risk of relapse after conventional penicillin doses, in patients with syphilis; at least 3-4 weeks of appropriate therapy are recommended. A number of other diseases caused by viruses, fungi, bacteria and parasites are less common; these include progressive multifocal leukoencephalopathy, herpes simplex and zoster infections and tuberculosis.
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PMID:Central nervous system opportunistic infections in HIV disease: clinical aspects. 134 47

We measured serum and CSF beta 2-microglobulin (beta 2M) levels in HIV-1 seropositive individuals with and without dementia to determine the frequency and diagnostic utility of elevation of CSF beta 2M. We compared 34 samples from 27 patients with HIV-1 dementia with 110 samples from 54 HIV-1 seropositive participants in the Multicenter AIDS Cohort Study, none of whom had progressive dementia. Neurosyphilis and CNS opportunistic processes were excluded in all subjects. We stratified the nondemented subjects by duration of HIV seropositivity and peripheral blood CD4 count. Compared with the nondemented group, demented subjects had significantly higher CSF total protein, IgG%, and CSF albumin/serum albumin ratios. A highly significant association was found between elevated CSF beta 2M and reduced CD4 count (p less than 0.0001). No significant differences were noted between the demented and nondemented groups in CSF WBC count or in the frequency of CSF HIV-1 isolation. The mean CSF beta 2M was 1.9 mg/l in the nondemented subjects compared with 4.2 mg/l in those with dementia (p less than 0.0001). We derived a cutoff of 3.8 mg/l from the distribution of CSF beta 2M in the nondemented group. The determination of CSF beta 2M had a sensitivity of 44%, specificity of 90%, and a positive predictive value of 88% for diagnosis of HIV dementia when compared with nondemented subjects with CD4 counts less than 200. In those without dementia, there was a strong correlation between serum and CSF beta 2M (r = 0.50, p less than 0.0001), but in demented subjects CSF beta 2M was elevated independently of serum levels, suggesting that CSF beta 2M is produced within the brain in HIV dementia. In the absence of CNS opportunistic processes, elevated CSF beta 2M greater than 3.8 mg/l is a clinically useful marker for HIV dementia.
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PMID:The diagnostic utility of elevation in cerebrospinal fluid beta 2-microglobulin in HIV-1 dementia. Multicenter AIDS Cohort Study. 135 86

AIDS is often accompanied by progressive encephalopathy and 'subcortical' dementia, but there is uncertainty regarding how early the brain involvement may begin in the course of HIV infection. This study used a cognitive auditory 'oddball' paradigm to elicit sensory and cognitive event related potential (ERP) components from healthy controls and from patients at different stages of HIV infection. Sensory component latencies did not differ between groups, but cognitive components showed progressive delays corresponding to increasingly severe clinical stages of HIV infection. The earliest changes were found among asymptomatic HIV + patients, suggesting that this test is a sensitive indicator of early subclinical CNS damage. In contrast, neither frequency analysis nor nonlinear dynamical analysis of the EEG showed differences between healthy controls and patients.
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PMID:HIV and the brain: evidence of early involvement and progressive damage. 139 64

Cerebral atrophy is a common radiologic manifestation of HIV dementia. To evaluate the relationship between cognitive impairment and cerebral atrophy, adjusting for age and immune status, we used standardized planimetry to measure the ventricle-brain ratio (VBR) and the bifrontal (BFR) and bicaudate (BCR) ratios, three measures of cerebral atrophy. We analyzed cranial MRIs of 23 HIV-1-seronegative controls (SN) and 116 HIV-1-infected individuals. Of the HIV-1-seropositive individuals, 37 had HIV dementia (DM group), 40 had neurologic or neuropsychological abnormalities insufficient for HIV dementia (NP+ group), and 39 were neurologically normal (NML group). We performed comparisons using analysis of covariance with correction for multiple comparisons. Both the VBR, a general measure of overall cerebral atrophy, and the BCR, a measure of atrophy in the region of the caudate nucleus, are significantly associated with dementia. The association is stronger for BCR enlargement than for VBR enlargement, suggesting that selective caudate region atrophy is associated with HIV dementia. These results indicate that overall cerebral atrophy and prominent caudate region atrophy are important radiographic features of HIV dementia.
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PMID:Patterns of cerebral atrophy in HIV-1-infected individuals: results of a quantitative MRI analysis. 143 22

Endogenous event-related potentials (and especially the P300 component) have delayed latencies relative to normal controls in patients with dementias of diverse aetiologies. Moreover, the subcortical varieties of dementia tend to affect also the early-stage N1 and P2 components whereas both types of dementias affect the later-stage N2 and P3 components. However it has become obvious that patients with HIV infection are susceptible to develop progressive, AIDS-related dementia, renamed 'HIV encephalopathy' by the Center for Disease Control. Several studies have shown that endogenous, but also early, components of long latency auditory evoked potentials are prolonged in latency in HIV-demented patients. However, these changes may also be present in class II and III patients and may permit the early recognition of HIV encephalopathy.
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PMID:[Cognitive evoked potentials and HIV infection]. 148 19

Human immunodeficiency virus (HIV) frequently enters the central nervous system (CNS) soon after infection, and frequently produces a wide variety of neurologic, cognitive, and psychiatric complications. Although, the entire spectrum of psychiatric illnesses may be seen in individuals with HIV infection, most are probably not directly caused by the virus. Psychiatric manifestations that are the direct result of HIV infection are usually seen in the setting of HIV-associated dementia. In this paper, it is proposed that these psychiatric manifestations of HIV infection can be phenomenologically separated into positive and negative symptoms. Negative symptoms are deficit states presenting as cognitive, social, or motivational deterioration; positive symptoms are psychotic or manic states that may occur in the course of the dementing illness. It is further purposed that there is a window of vulnerability to psychosis or mania that occurs relatively early in the dementing process. Consequently, advancing dementia would be expected to be associated with remission of psychosis.
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PMID:AIDS dementia-related psychosis: is there a window of vulnerability? 149 45

AIDS dementia complex is a well-defined neurological manifestation of the HIV infection. Its anatomo-pathological pattern is cerebral atrophy, grey and white matter abnormalities and vascular changes, and the main symptom is progressive dementia. SPECT with Tc 99m HMPAO has proved to be an useful tool in studying Alzheimer and multi-infarct dementia, and its use has been recently proposed in AIDS-dementia. We studied with Tc 99m HMPAO 57 Pts (11 HIV+, 26 ARC, 17 AIDS) and control group of 7 drug-addicted seronegative Pts. We found positive results in 45% SPECT, 18% CT, 0% neurological tests of dementia in HIV+ phase, versus 52%, 41, 20% in ARC phase and 94%, 88% and 76% in AIDS phase, while all control Pts were negative. Control group is too small to exclude with all possibility of doubt cerebral blood flow impairment caused by drug damage but nevertheless we think that SPECT examination with 99 mTc HMPAO has an important role in assessing CBF changes in earlier stages of AIDS disease. These changes are probably forerunners of definitive cerebral damage and may be important markers of the advancement of disease.
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PMID:[Use of 99mTc-HMPAO SPECT in the study of AIDS-correlated dementia]. 149 87

The role of the nef gene in human immunodeficiency virus type 1 (HIV-1) infection is poorly understood. To provide a basis for studies on the role of nef in AIDS, we used targeted polymerase chain reaction amplification and DNA sequencing to determine the structure of nef genes in pathologic tissue from HIV-1-infected children and adults. We find that the nef reading frame is open in 92% of clones derived from both brain and lymphocytic tissue of children, suggesting that nef is expressed in these tissues. One HIV-1 clone, BRVA, obtained by coculture from the brain of an adult AIDS patient with progressive dementia, was previously shown to contain a duplicated region in nef. We show here that similar duplications are widespread in both adults and children with AIDS. However, coculture strongly selects against the broad spectrum of nef quasispecies found in tissue. These findings suggest functional selection for nef quasispecies in pathologic tissues during HIV-1 infection of the human host.
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PMID:Human immunodeficiency virus type 1 nef quasispecies in pathological tissue. 150 Dec 74


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