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Semin Neurol 2014; 34(01): 007-013
DOI: 10.1055/s-0034-1372337
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evolving Character of Chronic Central Nervous System HIV Infection

Richard W. Price
1   Department of Neurology, University of California, San Francisco, California
,
Serena S. Spudich
2   Department of Neurology, Yale University, New Haven, Connecticut
,
Julia Peterson
1   Department of Neurology, University of California, San Francisco, California
,
Sarah Joseph
3   UNC Center for AIDS Research and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Dietmar Fuchs
4   Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
,
Henrik Zetterberg
5   Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden and Institute of Neurology, Queen Square, London, United Kingdom
,
Magnus Gisslén
6   Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
,
Ronald Swanstrom
3   UNC Center for AIDS Research and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
› Author Affiliations
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Publication History

Publication Date:
08 April 2014 (online)

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Abstract

Human immunodeficiency virus type 1 (HIV-1) infection of the central nervous system (CNS) begins early in systemic infection and continues throughout its untreated course. Despite a common cerebrospinal fluid inflammatory response, it is usually neurologically asymptomatic for much of this course, but can evolve in some individuals to HIV-associated dementia (HAD), a severe encephalopathy with characteristic cognitive and motor dysfunction. While widespread use of combination antiretroviral therapy (ART) has led to a marked decline in both the CNS infection and its neurologic severe consequence, HAD continues to afflict individuals presenting with advanced systemic infection in the developed world and a larger number in resource-poor settings where ART is more restricted. Additionally, milder CNS injury and dysfunction have broader prevalence, including in those treated with ART. Here we review the history and evolving nomenclature of HAD, its viral pathogenesis, clinical presentation and diagnosis, and treatment.

Keywords

HIV - dementia - treatment - brain - inflammation - cerebrospinal fluid - biomarkers