Neurological Infections in HIV: A Case-Based Review for Clinicians.

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Central Nervous System (CNS) diseases significantly impact morbidity and mortality in advanced HIV infection.
• Effective management is challenging in low-resource settings due to limited diagnostic and therapeutic capabilities.

Purpose of the Study:

• To present a structured, case-based clinical approach for diagnosing and managing common CNS manifestations in HIV.
• To provide practical guidance for healthcare providers in resource-limited environments.

Main Methods:

• Review of eight illustrative case scenarios covering diverse CNS syndromes in HIV.
• Emphasis on clinical reasoning, neuroimaging, cerebrospinal fluid analysis, and diagnostic integration.
• Application of a syndromic framework for differential diagnosis based on CD4 count and radiological patterns.

Main Results:

• Detailed discussion of meningeal syndromes, focal mass-like lesions, and white matter disorders.
• Integration of diagnostic findings (serologic, molecular) and clinical parameters.
• Principles of management including antimicrobial therapy, antiretroviral therapy initiation, and immune reconstitution inflammatory syndrome (IRIS) management.

Conclusions:

• The case-based, syndromic approach facilitates effective evaluation and management of HIV-associated CNS disease in resource-limited settings.
• Practical strategies are provided for optimizing patient care despite diagnostic and therapeutic constraints.