[Pathogenesis of neurological disorders in AIDS]

Impairment of the central nervous system (CNS) and peripheral nervous system (PNS) is common during the human immunodeficiency virus type 1 (HIV-1) infection. There are evidences of activated immune reactions in the CNS and PNS of patients with acquired immunodeficiency syndrome (AIDS). The expression of HIV-1 predominantly in monocyte/macrophage lineage cells strongly suggests immunopathogenetic mechanisms. Possible mechanisms of neuronal and glial cell damage include calcium dependent excitotoxicity by HIV-1 envelope protein, N-methyl-D-aspartate (NMDA) receptor-mediated neurotoxicity of quinolinic acid, injury of oligodendrocytes by tumor necrosis factor--alpha, cell injury by HIV-1-specific cytotoxic T cells, and apoptosis of oligodendrocytes or neurons. These mechanisms are not mutually exclusive. Multiple factors may be involved in the pathogenesis of HIV-1-associated neurological diseases.