Neurologic Complications of Acute HIV Infection
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HIV Medicine (C Yoon, Section Editor)
Neurologic Complications of Acute HIV Infection Kathryn B. Holroyd, MD1 Anastasia Vishnevetsky, MD1 Maahika Srinivasan, BA, MS2 Deanna Saylor, MD, MHS3,4,* Address 1 Department of Neurology, MGH-Brigham Neurology, Boston, MA, USA 2 Harvard Medical School, Boston, MA, USA 3 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA *,4 University of Zambia School of Medicine, Lusaka, Zambia Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on HIV Medicine Keywords Acute HIV infection I HIV reservoir I HIV cure I HIV-associated neurocognitive impairment I Neurological complications of HIV
Abstract Purpose of review This review focuses on the pathophysiology of acute HIV infection (AHI) and related central nervous system (CNS) pathology, the clinical characteristics of neurologic complications of AHI, and the implications of the CNS reservoir and viral escape for HIV treatment and cure strategies. Recent findings Recent studies in newly seroconverted populations show a high prevalence of peripheral neuropathy and cognitive dysfunction in AHI, even though these findings have been classically associated with chronic HIV infection. HIV cure strategies such as the “shock and kill” strategy are currently being studied in vitro and even in small clinical trials, though the CNS as a reservoir for latent HIV poses unique barriers to these treatment strategies. Summary Limited point of care diagnostic testing for AHI and delayed recognition of infection continue to lead to under-recognition and under-reporting of neurologic manifestations of AHI. AHI should be on the differential for a broad range of neurological conditions, from Bell’s palsy, peripheral neuropathy, and aseptic meningitis, to more rare manifestations such as ADEM, AIDP, meningoradiculitis, transverse myelitis, and brachial neuritis. Treatment for these conditions involves early initiation of antiretroviral therapy (ART) and then standard presentation-specific treatments. Current HIV cure strategies under investigation include bone marrow transplant, viral reservoir re-activation and eradication, and genome and epigenetic viral targeting. However, CNS penetration by HIV-1 occurs early on in the disease course with the establishment of the CNS viral reservoir and is an important limiting factor for these therapies.
HIV Medicine (C Yoon, Section Editor)
Introduction HIV-1 infection causes a myriad of both acute and chronic neurologic complications via direct viral damage or, in chronic infection, due to effects of the immunocompromised state. The most common direct effects of chronic HIV infection include HIV-associated neurocognitive disorders (HAND) and HIV-associated vacuolar myelopathy, while the immunocompromised state associated with poorly controlled chronic HIV
infection may predispose individuals to central nervous system (CNS) opportunistic infections such as toxoplasmosis, cryptococcus, and
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