Pearls: neurologic complications of HIV/AIDS

Clinically apparent and frequently debilitating neurologic disease is common with infection by HIV type 1. Approximately one half of all HIV-infected patients will develop clinically significant neurologic disease, and the frequency with which neuropathologic abnormalities are detected at autopsy in some series exceeds 90%, suggesting that neurologic findings are often overlooked. Not surprisingly, careful neurologic examination, even in the absence of specific complaints by the HIV-infected patient, often reveals evidence of central or peripheral nervous system dysfunction. Although neurologic disease typically occurs with advanced disease and profound immunosuppression, it may also occur during early stages of the infection. In as many as 20% of individuals, neurologic disease is the harbinger of AIDS. The spectrum of neurologic disorders that complicate HIV infection is extremely broad; any part of the neuraxis may be affected. Additionally, the complexity of evaluating the HIV-infected person with neurologic disease is increased by the relatively high frequency with which more than one disease concurrently affects the nervous system.