Nonopportunistic Neurologic Manifestations of HIV in India

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Nonopportunistic Neurologic Manifestations of the Human

Immunodeficiency Virus: An Indian Study

Posted 10/04/2005

Alaka K. Deshpande, MD; Mrinal M. Patnaik, MD

Abstract

Context

HIV-1 is a neurotropic virus. In a resource-limited country such as

India, large populations of affected patients now have access to

adequate chemoprophylaxis for opportunistic infections (OIs),

allowing them to live longer. Unfortunately the poor availability of

highly active antiretroviral therapy (HAART) has allowed viral

replication to proceed unchecked. This has resulted in an increase

in the debilitating neurologic manifestations directly mediated by

the virus.

Objective

The main objective of this study was to identify and describe in

detail the direct neurologic manifestations of HIV-1 in

antiretroviral treatment (ART)-naive, HIV-infected patients

(excluding the neurologic manifestations produced by opportunistic

pathogens).

Design

Three hundred successive cases of HIV-1 infected, ART-naive patients

with neurologic manifestations were studied over a 3-year period.

Each case was studied in detail to identify and then exclude

manifestations due to opportunistic pathogens. The remaining cases

were then analyzed specially in regard to their occurrence and the

degree of immune suppression (CD4+ cell counts).

Setting and Patients

The study was carried out in an apex, tertiary, referral care center

for HIV/AIDS in India. All patients were admitted for a detailed

Analysis.

No interventions were carried out, as this was an observational

study.

Results

Of the 300 cases, 67 (22.3%) had neurologic manifestations due to

the direct effects of HIV-1. The HIV infection involved the

neuroaxis at all levels. The distribution of cases showed that the

region most commonly involved was the brain (50.7%). The

manifestations included stroke syndromes (29.8%), demyelinating

illnesses (5.9%), AIDS dementia complex (5.9%), and venous sinus

thrombosis (4.4%). The other manifestations seen were peripheral

neuropathies (35.8% of cases), spinal cord pathologies (5.9% of

cases), radiculopathies (4.4% of cases), and a single case of

myopathy. The onset of occurrence of these diseases and their

progression were then correlated with the CD4+ cell counts.

Conclusions

HIV infection is responsible for a large number of nonopportunistic

neurologic manifestations that occur across a large immune spectrum.

During the early course of the disease, the polyclonal

hypergammaglobulinemia induced by the virus results in demyelinating

diseases of the central- and peripheral nervous systems (CNS and

PNS). As the HIV infection progresses, the direct toxic effects of

the virus unfold, directly damaging the CNS and PNS, resulting in

protean clinical manifestations.

Alaka K. Deshpande, MD, Professor and Head, Department of Retroviral

Medicine, Grant Medical College & Sir JJ Group of Hospitals, Mumbai,

India.

Email: alakadeshpande@....

Mrinal M. Patnaik, MD, Chief Resident, Department of Retroviral

Medicine, Grant Medical College & Sir JJ Group of Hospitals, Mumbai,

India

Disclosure: Alaka K. Deshpande, MD, has disclosed no relevant

financial relationships.

Disclosure: Mrinal M. Patnaik, MD, has disclosed no relevant

financial relationships.

Medscape General Medicine. 2005;7(3) ©2005 Medscape

http://www.medscape.com/viewarticle/511865