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Human immunodeficiency virus-associated meningitis. Clinical course and correlations
1School of Medicine, University of California, San Francisco 94143.
Abstract:
Fourteen patients infected with human immunodeficiency virus (HIV) had a lymphocytic pleocytosis unexplained by secondary pathogens or neoplasms. Three men had prior diagnoses of Kaposi's sarcoma; none had acquired immune deficiency syndrome-defining opportunistic infections. Two patterns of illness were observed. Seven men had an acute, self-limited illness that was often accompanied by meningeal findings. The other seven had chronic headaches without signs of meningeal irritation and had less marked abnormalities of cerebrospinal fluid (CSF) cell count and protein. Encephalopathy was a finding in only one of 14 patients. In four of five CSF specimens studied, HIV was recovered. HIV has been associated with acute meningitis at the time of seroconversion and can apparently also cause sporadic episodes of acute or chronic meningitis in patients with prior infection and relatively preserved immune function. Both the clinical presentation with predominant headache rather than encephalopathy and the presence of CSF inflammation differentiate this syndrome from other HIV-related neurologic complications.
Insights
Human immunodeficiency virus (HIV) can cause meningitis, presenting as acute or chronic illness with headaches. This neurological complication is distinct from other HIV-related conditions and involves inflammation in the cerebrospinal fluid.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Human immunodeficiency virus (HIV) infection can lead to various neurological complications.
- Lymphocytic pleocytosis in HIV patients may indicate central nervous system involvement.
- Distinguishing HIV-related neurological syndromes is crucial for patient management.
Purpose of the Study:
- To describe a specific meningitis syndrome in HIV-infected patients.
- To differentiate this syndrome from other HIV-associated neurological disorders.
- To investigate the presence of HIV in cerebrospinal fluid (CSF) during these episodes.
Main Methods:
- Retrospective analysis of 14 HIV-infected patients with unexplained lymphocytic pleocytosis.
- Clinical evaluation including neurological examination and assessment of symptoms like headache and encephalopathy.
- Cerebrospinal fluid (CSF) analysis for cell count, protein levels, and HIV detection.
Main Results:
- Two clinical patterns observed: acute, self-limited meningitis (7 patients) and chronic meningitis with headaches (7 patients).
- Encephalopathy was rare (1 of 14 patients).
- HIV was recovered from CSF in 4 of 5 specimens, confirming direct viral involvement.
Conclusions:
- HIV can cause both acute and chronic meningitis in infected individuals, even with preserved immune function.
- The syndrome is characterized by predominant headache and CSF inflammation, differentiating it from other HIV neurological complications.
- This highlights the diverse neurological manifestations of HIV infection.