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Handb Clin Neurol 2018 ;152:99-116

Department of Infectious Diseases, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

The human immunodeficiency virus-1 (HIV-1) enters the central nervous system compartment within the first few weeks of systemic HIV infection and may cause a spectrum of neurologic complications. Without combination antiretroviral therapy (cART), 50-90% of all HIV-infected infants and children develop some form of neuroAIDS. Of the estimated 2. Read More

J Infect Chemother 2018 Mar 11;24(3):220-223. Epub 2017 Nov 11.

National Center for Global Health and Medicine, Department of Pediatrics, Japan.

In the era of Antiretroviral Therapy (ART) in which human immunodeficiency virus type 1 (HIV-1) infection affected children can expect a better prognosis, the importance of careful follow up of pediatric HIV-1 cases for neurological complications has been growing. We present a case of hemorrhagic Moyamoya syndrome in a child with congenital HIV-1 infection. A 10-year-old girl was referred to our hospital for the treatment of Pneumocystis Jirovecii Pneumonia (PCP: Pneumocystis pneumonia). Read More

Curr Neurol Neurosci Rep 2016 07;16(7):62

Departments of Neurology and Medicine (Infectious Diseases), University of California, San Francisco, CA, USA.

Effective combination antiretroviral therapy has transformed HIV infection into a chronic disease, with HIV-infected individuals living longer and reaching older age. Neurological disease remains common in treated HIV, however, due in part to ongoing inflammation and immune activation that persist in chronic infection. In this review, we highlight recent developments in our understanding of several clinically relevant neurologic complications that can occur in HIV infection despite treatment, including HIV-associated neurocognitive disorders, symptomatic CSF escape, cerebrovascular disease, and peripheral neuropathy. Read More

J Child Neurol 2016 07 9;31(8):1010-7. Epub 2016 Mar 9.

Department of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa

A national multicenter study identified 17 South African children with vertically acquired HIV-1 infection and HIV-associated vasculopathy. Five of the children (all indigenous African ancestry) had progressive vascular disease, consistent with moyamoya syndrome. Median presentation age 5. Read More

Dev Med Child Neurol 2016 05 18;58(5):452-60. Epub 2016 Feb 18.

Department of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

An estimated 3.2 million children worldwide have human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) has resulted in prolonged survival, leading to an increase in complications previously recognized in adults. Read More

J Infect Dis 2015 Jan 31;211(2):178-86. Epub 2014 Jul 31.

San Paolo Hospital.

Background: Chronic cytomegalovirus (CMV) infection has been associated with immunosenescence and immunoactivation in the general population. In human immunodeficiency virus type 1 (HIV-1)-infected people, CMV coinfection, in addition to residual HIV replication and microbial translocation, has been proposed as a key factor in sustaining immune activation, even in individuals with a controlled HIV load.

Methods: Patients from the ICONA Study with at least 1 CMV immunoglobulin G (IgG) test available without active CMV disease were included in the analysis. Read More

J Immunol 2014 May 11;192(10):4674-84. Epub 2014 Apr 11.

Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642.

HIV-1-associated neuroinflammation persists even with effective combined antiretroviral therapy, and it is associated with the presence of activated monocytes/macrophages within the CNS. To infiltrate the CNS, monocytes transmigrate across the selectively permeable blood-brain barrier, which is compromised during HIV-1 infection. Interestingly, platelet-derived excess soluble CD40 ligand found in the plasma and cerebrospinal fluid of HIV-1-infected individuals with cognitive impairment has previously been implicated in increased blood-brain barrier permeability. Read More

Pan Afr Med J 2013 4;16. Epub 2013 Sep 4.

Department of Internal Medicine, University of Botswana, Gaborone, Botswana.

Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke. Read More

PLoS One 2014 31;9(1):e87160. Epub 2014 Jan 31.

Department of Medicine I, Infectious Diseases Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Background: The impact of immunosuppression despite virological suppression (immuno-virological discordance, ID) on the risk of developing fatal and non-fatal AIDS/non-AIDS events is unclear and remains to be elucidated.

Methods: Patients in EuroSIDA starting at least 1 new antiretroviral drug with CD4<350 cells/µl and viral load (VL)>500 copies/mL were followed-up from the first day of VL< = 50 copies/ml until a new fatal/non-fatal non-AIDS/AIDS event. Considered non-AIDS events included non-AIDS malignancies, pancreatitis, severe liver disease with hepatic encephalopathy (>grade 3), cardio- and cerebrovascular events, and end-stage renal disease. Read More

Antivir Ther 2014 16;19(3):309-17. Epub 2014 Jan 16.

Toronto General Research Institute, University Health Network, Toronto, ON, Canada.

Background: The increased risk for cardiovascular disease (CVD) in HIV is well established. Despite high prevalence of viral hepatitis coinfection with HIV, there are few studies on the risk of CVD amongst antiretroviral therapy (ART)-treated coinfected patients.

Methods: Ontario HIV Treatment Network Cohort Study participants who initiated ART without prior CVD events were analysed. Read More

J Neuroinflammation 2012 Nov 20;9:253. Epub 2012 Nov 20.

Department of Microbiology and Immunology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, USA.

Background: Cerebral blood flow (CBF) is known to be dysregulated in persons with human immunodeficiency virus 1 (HIV-1), for uncertain reasons. This is an important issue because impaired vasoreactivity has been associated with increased risk of ischemic stroke, elevated overall cardiovascular risk and cognitive impairment.

Methods: To test whether dysregulation of CBF might be due to virally-induced neuroinflammation, we used a well-defined animal model (GFAP-driven, doxycycline-inducible HIV-1 Tat transgenic (Tat-tg) mice). Read More

Clin Neuropsychol 2010 Feb;24(2):265-85

UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095-8353, USA.

This study examined the interactive effects of cerebrovascular risks, advancing age, and HIV infection on neurocognition, and explored whether pharmacological treatment of cerebrovascular risk factors attenuated neurocognitive dysfunction. Participants included 98 HIV-seropositive adults (cerebrovascular risk: 23.5%; age > 50: 27. Read More

Cerebrovasc Dis 2009 24;27(6):559-63. Epub 2009 Apr 24.

Stroke Unit, Neurology Service, Hospital Ramón y Cajal, Madrid, Spain.

Background: Stroke risk is increased in AIDS patients, and highly active antiretroviral therapy (HAART) may accelerate atherosclerosis, but little is known about the incidence and risk factors for ischemic stroke in patients under HAART. We have studied the incidence, types of stroke and possible risk factors for cerebrovascular ischemic events in a large cohort of HIV-1-infected patients treated with HAART.

Methods: We conducted a retrospective review of ischemic strokes and transient ischemic attacks occurring in a cohort of HIV-1-infected patients treated with HAART from 1996 to 2008. Read More

Int J Cardiol 2009 Apr 7;133(3):293-306. Epub 2009 Jan 7.

AP-HP, Hôpital René Muret, Policlinique médicale, Université Paris, Sevran, France.

After more than two decades of AIDS epidemic, the spectrum of HIV-associated vascular diseases has mainly evolved from infectious and inflammatory vasculitides to premature atherosclerosis, its related contributing conditions (metabolic syndrome, dyslipidemia, insulin resistance syndrome) and complications (acute coronary and cerebrovascular syndromes). Today, as the AIDS epidemic further progresses worldwide and as the life expectancy of HIV-infected patients treated with effective antiviral regimens has dramatically increased, more than 10% of patients experience cardiovascular manifestations. The complex interplay between viral infection, inflammatory and cytokines pathways, protease inhibitors-induced hyperlipidemia and direct effects on endothelial cells has not, by far, been integrated in a single comprehensive pathogenesis network. Read More

Clin Neuropathol 2008 Jan-Feb;27(1):37-52

Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India.

Central nervous system manifestations of acquired immunodeficiency syndrome (AIDS) in children differ strikingly from adults. Developmental delay, subacute AIDS encephalitis and basal ganglia calcification are common in children, in contrast to opportunistic infections and dementia in adults. Intracranial aneurysms are being recognized with increasing frequency in pediatric AIDS. Read More

Arq Neuropsiquiatr 2007 Dec;65(4A):1010-1

Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros 566/93, SP, Brazil.

Cerebellar disorders associated with HIV infection are usually caused by opportunistic infections, central nervous system lymphoma, and toxic effects of medicines, nutritional and metabolic disorders, and cerebrovascular disease. We present an unusual association of cerebellar degeneration and immune thrombocytopenic purpura in a 28-years-old woman HIV infected. An autoimmune aetiology is likely. Read More

J NeuroAIDS 1999 ;2(2):57-64

Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY 14642, USA.

We report two young adults with the acquired immunodeficiency syndrome (AIDS), one who presented with multiple ischemic cerebral infarctions and the other who presented with multiple episodes of transient neurologic deficit. Both patients had pulmonary hypertension and a patent foramen ovale (PFO) by echocardiogram. To our knowledge, this is the first report describing HIV-associated pulmonary hypertension and PFO in HIV infected patients with presumed embolic cerebrovascular disease. Read More

QJM 2004 Jul;97(7):413-21

Division of Radiology, Department of Radiation Sciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Background: HIV-associated focal brain lesions (HFBL) are caused by opportunistic infections, neoplasms, or cerebrovascular diseases. In developed countries, toxoplasma encephalitis (TE) is the most frequent cause, followed by primary CNS lymphoma (PCNSL). Guidelines based on these causes however are poorly suited to developing countries, where treatable infections predominate as causes of HFBL. Read More

AIDS 2004 Jan;18 Suppl 1:S79-86

University of Hawaii, NeuroAIDS Specialized Neuroscience Research Program, John A. Burns School of Medicine, Honolulu, Hawaii 96816, USA.

Individuals over 50 years of age comprise 11% of AIDS cases reported to the Centers for Disease Control and Prevention. A higher prevalence of AIDS in older individuals has been reported in certain states including Hawaii (20%) and Florida (13%). Although life expectancy in individuals with AIDS has increased with advances in antiretroviral therapy, it is likely that there are health consequences both of long-term infection and chronic antiretroviral therapy. Read More

Rev Neurol 2002 Nov 1-15;35(9):808-11

Policlinico Docente "Heroes del Moncada". Municipio de Salud Plaza, La Habana, Cuba.

Introduction: Cerebrovascular disease (CVD) has become an important health problem throughout the world. It is generally one the main causes of morbidity and mortality in the world, especially in developed countries. In these countries the frequency with which it appears is linked with the progress reached in the organisation of the public health system and the higher economic and social standards of their populations, which have given rise to prolonged life expectancy and a greater number of elderly people. Read More

J Clin Epidemiol 2001 Dec;54 Suppl 1:S35-43

Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1400 NW 10th Ave, #803-A, Miami, FL 33136, USA.

Older individuals (>50 years of age) now comprise over 11% of patients with AIDS in the United States. This percentage is expected to continue to grow, due both to the improved longevity of patients prescribed highly active antiretroviral therapy (HAART) and to new infections among older individuals. This review focuses on the neuropsychiatric and neurological conditions that are most likely to be affected by advancing age-HIV-1-associated cognitive-motor disorder, peripheral neuropathy, progressive multifocal leukoencephalopathy, primary CNS lymphoma, and risk for cerebrovascular accident. Read More

J Hum Virol 2000 Nov-Dec;3(6):324-34

Center for Human Virology, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

Objective: An in vitro blood-brain barrier (BBB) system was developed using primary cultures of human brain-derived microvascular endothelial cells (MVECs), macrophages, neuronal cells, and human fetal astrocytes. This BBB system simulates important morphologic and permeability characteristics of the BBB in vivo. This system could be used to study human neurologic/neurovirologic disorders. Read More

J Nutr 1996 10;126(10 Suppl):2663S-2673S

Cooper Hospital/University Medical Center, Camden, New Jersey 08103, USA.

Human immunodeficiency virus type-1 (HIV-1)-associated neurologic disease, known as "HIV-1-associated progressive encephalopathy" (PE), is a common concomitant in the progression towards AIDS. PE, characterized by a triad of symptoms including impaired brain growth, progressive motor dysfunction, and loss or plateau of developmental milestones, is believed to result from both direct and indirect effects of HIV-1 infection on the central nervous system (CNS). Consequent to the hallmark systemic immune deficiency of HIV infection, the CNS becomes susceptible to opportunistic infections which add further morbidity and mortality, and may contribute either directly or indirectly to neurologic symptoms which can often mimic PE. Read More

Stroke 1996 Mar;27(3):538-43

Department of Epidemiology and Preventive Medicine, University of Maryland at Baltimore, USA.

Background: Although neurological complications of human immunodeficiency virus (HIV) infection are common, the presence of cerebrovascular disease (CVD) has been seldom reported. The purpose of this report is to review available data on the association between stroke and acquired immunodeficiency syndrome (AIDS).

Summary Of Review: A review of all literature published between mid-1976 and December 1994 was performed through a MEDLINE search with the following key words: AIDS, CVD, human T-cell lymphotropic virus type III, and HIV-1. Read More

Ann N Y Acad Sci 1993 Oct;693:93-106

Department of Pathology (Neuropathology), Albert Einstein College of Medicine, Bronx, New York 10461.

Children with AIDS frequently have neurological manifestations due to complications of immunodeficiency or intrinsic effects of human immunodeficiency virus type 1 (HIV-1) on the central nervous system (CNS). The most common neurological disorders not directly related to HIV-1 infection include cerebrovascular disease and lymphoma. Global anoxic-ischemic and necrotizing encephalopathies are frequent, while CNS hemorrhages and arteriopathies are less frequent. Read More

Dig Dis Sci 1993 Jun;38(6):1152-5

Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903-0019.

Although patients with AIDS frequently develop high titers of anticardiolipin antibodies, the clinical significance of this laboratory abnormality in AIDS patients is unknown. A 33-year-old female with AIDS, a prior small cerebrovascular accident, thrombocytopenia, and a coagulopathy suddenly developed left upper quadrant pain and tenderness due to splenic infarction associated with a high titer of anticardiolipin antibodies. Possible clinical manifestations of anticardiolipin antibodies in this patient include recurrent thromboembolism, coagulopathy, and thrombocytopenia. Read More

FASEB J 1991 Jul;5(10):2391-7

Department of Neurology, University of California, School of Medicine, Los Angeles 90024.

Hallmarks of central nervous system (CNS) disease in AIDS patients are headaches, fever, subtle cognitive changes, abnormal reflexes, and ataxia. Dementia and severe sensory and motor dysfunction characterize more severe disease. Autoimmune-like peripheral neuropathies, cerebrovascular disease, and brain tumors are also observed. Read More

J Neuropathol Exp Neurol 1990 Jul;49(4):357-70

Department of Pathology (Neuropathology), University of Massachusetts Medical Center, Worcester 01655.

We studied the brains of three patients with acquired immune deficiency syndrome (AIDS), all of whom developed subacutely progressive dementia unassociated with opportunistic infection or neoplasm in the central nervous system. Computed tomographic (CT) scans of the head revealed cortical atrophy, ventricular dilation, and diffuse hypodensity of the centrum semiovale. On microscopic examination, the cerebral and cerebellar white matter in all cases showed diffuse and focal, angiocentric regions of myelin pallor, focal vacuolization, and extensive gliosis. Read More