Sunday, 28 July 2013

Neurological Complications With HIV

For those readers with neuropathy caused by HIV or its medication, today's post from (see link below) should be of interest. Unfortunately HIV can bring a variety of neurological problems to your health table, of which neuropathy is possible the most common. These problems are not generally caused by secondary infections due to a reduced immune system but more likely due to the virus itself attacking the nervous system. It's always useful to be aware of possibilities, especially if your nervous system is already compromised in some way and although this list may seem alarming; it's useful to know what to look out for. 

Neurological Complications of HIV:
The Virus Does More Than Just Lower the Immune System

By Peter Pressman, M.D., Guide Updated July 26, 2013 Health's Disease and Condition content is reviewed by the Medical Review Board

Most people recognize that the human immunodeficiency virus (HIV) can reduce the body's ability to fight infections. After all, that's why HIV is named what it is. What is less well known is that even without inviting other infections to attack the body, HIV is fully capable of significantly damaging the human nervous system on its own. Whether it's the brain, spinal cord, nerve, or muscle, there's almost no part of the nervous system that HIV can't hurt, and almost no disorder it can't mimic.

HIV Dementia

HIV enters the brain early on in the disease course, and can lead to severe cognitive changes, including slowness in thought and movement, mood changes, and poor decision making. Learn more by reading HIV-associated Neurocognitive Disorders.

HIV Vasculitis

HIV can affect the blood vessels in the body, including those of the brain. The vessels can constrict, leading to reduced blood flow. Strokes can result.

HIV Peripheral Neuropathy and Autonomic Neuropathies

HIV can cause almost any kind of peripheral neuropathy. Most of the time, the peripheral neuropathy associated with HIV is slow and gradual. Sometimes, though, it can be much more rapid, mimicking Guillain-Barré syndrome.

The most common type of neuropathy caused by HIV is a slowly progressive numbness that affects the ends of the nerves first, with numbness of the hands and feet that then spreads inwards. Unfortunately, some HIV medications have the same effect.

In addition to numbness and weakness, HIV can cause an autonomic neuropathy, just affecting the body's control of things like temperature, blood pressure, and sweating.

Transverse Myelitis and Progressive Myelopathy

HIV can cause inflammation in the spinal cord, cutting off communication between the brain and the body below the level of the lesion. Limb weakness or paralysis, sensory loss, and loss of bladder or bowel control can result. This happens very quickly in transverse myelitis, but can actually occur in a more gradual fashion in progressive myelopathy.


Rarely, muscle pain and weakness can result from HIV infection. Lab tests will show elevated levels of a chemical called creatine kinase in the blood, and electromyography will show tell-tale changes.

Myopathy of Chronic Infection

Muscles close to the torso of the body may become progressively weaker due to chronic HIV infection. However, some medications used to treat HIV, such as zidovudine (AZT), can have a similar effect.


A stiff neck, fever, and headache as well as generally feeling sick are signs of meningitis, an infection of the tissues that surround the brain. Many viruses can cause meningitis, including herpes, cytomegalovirus and HIV.
Meningitis due to HIV itself is usually in the early stage of the infection. Later on, HIV can cause opportunistic infections or even cancers that then lead to a meningitis. It's important to note that early on, some HIV blood tests may appear normal, and HIV can only be found with more specialized testing.

Cranial Neuropathies

The cranial nerves include nerves that control facial muscles and those that help us hear. Both have been damaged in early HIV infection, leading to something like a Bell's palsy or hearing loss. In general, recovery is the rule.


Seizures can result from HIV infection, either due to lowering of the body's seizure threshold or due to local stresses near the cortex.

Rarer Manifestations

Although cases are few, HIV has caused inflammation of the cerebellum which leads to clumsy movements known as ataxia. It may even have caused disease in the anterior horn of the spinal cord, mimicking amyotrophic lateral sclerosis (ALS).

As you see, there's more to HIV than simply lowering the body's immune system to allow attacks by infectious agents that would normally be fought off. The virus itself is capable of causing all kinds of havoc to the nervous system, even though it normally never directly infects nerve cells. This is all the more reason to ensure that the AIDS pandemic is put to an end.

Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology 1991; 41:778.

Price RW. Neurological complications of HIV infection. Lancet 1996; 348:445.

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