The neurologic complications of human immunodeficiency virus infection

The physician caring for HIV-1-infected patients must have a good working knowledge of the broad spectrum of neurologic diseases that occur in association with this infection. As with any other neurologic disorder, the site of the neuraxis that is affected must be properly identified. In HIV-1-infected persons, more than one site may be involved simultaneously, such as the coexistence of myelopathy and peripheral neuropathy, often resulting in a confusing array of neurologic signs and symptoms. The frequent occurrence of two or more diseases affecting the neuraxis, such as progressive multifocal leukoencephalopathy and toxoplasmosis, further complicates the picture. With the AIDS patient, the physician cannot rely on the clinical adage that all attempts should be made to ascribe the patient's problems to one disease. Often, it is not the case. As with other illnesses, the approach to the HIV-1-infected person with neurologic disease needs to be thorough and fluid. After rendering a diagnosis and embarking on therapy, the physician needs to be open minded about the possibility of an incorrect or additional diagnosis not previously considered. Lastly, despite all the knowledge that has been accumulated in the first decade of the AIDS epidemic, new illnesses occurring with HIV-1 infection are recognized with regularity. The physician must always bear in mind that the illness with which he or she is confronted may be one that has not been previously described.