Atypical nervous system manifestations of HIV

Despite the widespread success of combination antiretroviral therapy (cART) in reducing morbidity and mortality in human immunodeficiency virus 1 (HIV-1) infection, HIV-associated neurologic disease remains prevalent. Although the virus is unable to infect neurons or muscle fibers directly, it can still injure these structures by a variety of mechanisms, many of which are yet to be elucidated. Additionally, antiretroviral medications used to treat HIV infection can cause damage to the nervous system both by direct toxicity and via modulation of host-virus interactions. Some neurologic complications of HIV infection are rarely seen and are poorly understood; nevertheless, they are important to recognize. In this review article, the authors focus on the uncommon neurologic manifestations of HIV infection, including mononeuropathies, inflammatory demyelinating polyneuropathies, motor neuron disease, polymyositis, diffuse infiltrative lymphocytosis syndrome, mononeuritis multiplex, HIV-associated neuromuscular weakness syndrome, immune reconstitution inflammatory syndrome, and central nervous system HIV-escape meningoencephalomyelitis and myelitis.