Focal Affections of CNS in Patients with HIV Infection

Authors: R. Černý 1;  J. Kapla 2;  L. Machala 3
Authors‘ workplace: Neurologická klinika dospělých 2. LF UK a FN v Motole, Praha 1;  Klinika infekčních nemocí LF UK a FN Hradec Králové 2;  I. infekční klinika 2. LF UK a Klinika infekčních nemocí 3. LF UK, FN Na Bulovce, Praha 3
Published in: Cesk Slov Neurol N 2010; 73/106(4): 374-378
Category: Review Article


Focal affections of the CNS are an important cause of morbidity and mortality in HIV-infected patients. HIV infection is rarely considered in patients with focal CNS symptomatology in the Czech Republic, a setting with low prevalence of HIV positivity. Nevertheless, delay in establishing a correct diagnosis has a negative influence on the patient’s prognosis and puts health-care workers at risk of infection. The most important causes of focal CNS affections in HIV-positive patients are: brain toxoplasmosis, primary CNS lymphoma, and progressive multifocal leuko-encephalopathy. The aetiology of other focal CNS affections in HIV-positive persons is similar to the situation in the normal population, but the incidence of these CNS affections in HIV-positive patients tends to be higher. A possible connection with HIV infection should be always taken in account, in order to establish a correct diagnosis as soon as possible, when the therapy can be most effective.

Key words:
HIV – focal CNS affections – brain toxoplasmosis – primary lymphoma


1. Brew B. HIV Neurology. In: Gilman S, Herdman W (eds). Contemporary Neurology Series. New York: Oxford University Press 2001.

2. Britton CB, Miller JR. Neurologic complications in acquired immunodeficiency syndrome (AIDS). Neurol Clin 1984; 2(2): 315–339.

3. Gong V. Acquired immunodeficiency syndrome (AIDS). Am J Emerg Med 1984; 2(4): 336–346.

4. Levy JA, Kaminsky LS, Morrow WJ, Steimer K, Luciw P, Dina D et al. Infection by the retrovirus associated with the acquired immunodeficiency syndrome. Clinical, biological, and molecular features. Ann Intern Med 1985; 103(5): 694–699.

5. Portegies P, Solod L, Cinque P, Chaudhuri A, Begovac J, Everall I et al. Guidelines for the diagnosis and management of neurological complications of HIV infection. Eur J Neurol 2004; 11(5): 297–304.

6. Snider WD, Simpson DM, Nielsen S, Gold JW, Metroka CE, Posner JB. Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 1983; 14(4): 403–418.

7. Whelan MA, Kricheff II, Handler M, Ho V, Crystal K, Gopinathan G et al. Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations. Radiology 1983; 149(2): 477–484.

8. Koppel BS, Wormser GP, Tuchman AJ, Maayan S, Hewlett D Jr, Daras M. Central nervous system involvement in patients with acquired immune deficiency syndrome (AIDS). Acta Neurol Scand 1985; 71(5): 337–353.

9. Černý R, Machala L, Hobstová J. Neurologické projevy akutní HIV infekce. Cesk Slov Neurol N 2004; 67/100(2): 84–88.

10. Trujillo JR, Jaramillo-Rangel G, Ortega-Martinez M, Penalva de Oliveira AC, Vidal JE, Bryant J et al. International NeuroAIDS: prospects of HIV-1 associated neurological complications. Cell Res 2005; 15(11–12): 962–969.

11. Abgrall S, Rabaud C, Costagliola D. Incidence and risk factors for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active antiretroviral therapy era. Clin Infect Dis 2001; 33(10): ­1747–1755.

12. Olatinwo TF, Herbowy MT, Hewitt RG. Toxoplasmic encephalitis and primary lymphoma of the brain - the shift in epidemiology: a case series and review of the literature. AIDS Read 2001; 11(9): 444–449.

13. Bohutová J, Štrof J, Staňková M. Postižení mozku u nemocných s HIV/AIDS v CT obraze. Ces Radiol 2001; 55: 351–355.

14. Sell M, Sander B, Klingebiel R. Ventriculitis and hydrocephalus as the primary manifestation of cerebral toxoplasmosis associated with AIDS. J Neurol 2005; 252(2): 234–236.

15. Bartlett J, Gallant J. Medical management of HIV infection. Baltimore: John Hopkins Medicine Health Publishing Business Group 2004.

16. Gildenberg PL, Gathe JC Jr, Kim JH. Stereotactic biopsy of cerebral lesions in AIDS. Clin Infect Dis 2000; 30(3): 491–499.

17. MacMahon EM, Glass JD, Hayward SD, Mann RB, Becker PS, Charache P et al. Epstein-Barr virus in AIDS-related primary central nervous system lymphoma. Lancet 1991; 338(8773): 969–973.

18. Skiest DJ, Crosby C. Survival is prolonged by highly active antiretroviral therapy in AIDS patients with primary central nervous system lymphoma. AIDS 2003; 17(12): 1787–1793.

19. Korfel A, Thiel E. Successful treatment of non-Hodgkin’s lymphoma of the central nervous system with BMPD chemotherapy followed by radiotherapy. Leuk Lymphoma 1998; 30(5–6): 609–617.

20. Gavrilovic IT, Abrey LE. Diagnosis and treatment of primary central nervous system lymphoma. Curr Oncol Rep 2005; 7(1): 47–54.

21. Pels H, Schmidt-Wolf IG, Glasmacher A, Schulz H, Engert A, Diehl V et al. Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy. J Clin Oncol 2003; 21(24): 4489–4495.

22. Weber T. Progressive multifocal leukoencephalopathy. Neurol Clin 2008; 26(3): 833–854.

23. Berger J, Levy M. Progressive multifocal leukoencephalopathy. In: Berger J, Levy R (eds). AIDS and the Nervous System. 2nd ed. Philadelphia: Lippincott-Raven Publishers 1997: 569–594.

24. Bakshi R. Neuroimaging of HIV and AIDS related illnesses: a review. Front Biosci 2004; 9: 632–646.

25. Cinque P, Scarpellini P, Vago L, Linde A, Lazzarin A. Diagnosis of central nervous system complications in HIV-infected patients: cerebrospinal fluid analysis by the polymerase chain reaction. AIDS 1997; 11(1): 1–17.

26. Aksamit AJ. Progressive multifocal leukoencephalopathy. Curr Treat Options Neurol 2008; 10(3): 178–185.

27. d’Arminio Monforte A, Cinque P, Mocroft A, Goebel FD, Antunes F, Katlama C et al. Changing incidence of central nervous system diseases in the EuroSIDA cohort. Ann Neurol 2004; 55(3): 320–328.

28. Cole JW, Pinto AN, Hebel JR, Buchholz DW, Earley CJ, Johnson CJ et al. Acquired immunodeficiency syndrome and the risk of stroke. Stroke 2004; 35(1): 51–56.

29. d’Arminio A, Sabin CA, Phillips AN, Reiss P, Weber R, Kirk O et al. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004; 18(13): 1811–1817.

30. Ortiz G, Koch S, Romano JG, Forteza AM, Rabin­stein AA. Mechanisms of ischemic stroke in HIV-infected patients. Neurology 2007; 68(16): 1257–1261.

31. Engstrom JW, Lowenstein DH, Bredesen DE. Cerebral infarctions and transient neurologic deficits associated with acquired immunodeficiency syndrome. Am J Med 1989; 86(5): 528–532.

32. Picard O, Brunereau L, Pelosse B, Kerob D, Cabane J, Imbert JC. Cerebral infarction associated with vasculitis due to varicella zoster virus in patients infected with the human immunodeficiency virus. Biomed Pharmacother 1997; 51(10): 449–454.

33. Peters M, Gottschalk D, Boit R, Pohle HD, Ruf B. Meningovascular neurosyphilis in human immunodeficiency virus infection as a differential diagnosis of focal CNS lesions: a clinicopathological study. J Infect 1993; 27(1): 57–62.

34. Zellan J, Augenbraun M. Syphilis in the HIV-infected patient: an update on epidemiology, diagnosis, and management. Curr HIV/AIDS Rep 2004; 1(3): 142–147.

35. de Larrañaga GF, Forastiero RR, Carreras LO, Alonso BS. Different types of antiphospholipid antibodies in AIDS: a comparison with syphilis and the antiphospholipid syndrome. Thromb Res 1999; 96(1): 19–25.

36. Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003; 348(8): 702–710.

37. Kulasekaram R, Peters BS, Wierzbicki AS. Dyslipidaemia and cardiovascular risk in HIV infection. Curr Med Res Opin 2005; 21(11): 1717–1725.

38. Taiwo BO. Insulin resistance, HIV infection, and anti-HIV therapies. AIDS Read 2005; 15(4): 171–176, 179–180.

39. Friis-Møller N, Weber R, Reiss P, Thiébaut R, Kirk O, d’Arminio Monforte A et al. Cardiovascular disease risk factors in HIV patients – association with antiretroviral therapy. Results from the DAD study. AIDS 2003; 17(8): 1179–1193.

40. Sax PE. Strategies for management and treatment of dyslipidemia in HIV/AIDS. AIDS Care 2006; 18(2): 149–157.

41.Arbuthnot C, Wilde JT. Increased risk of bleeding with the use of tipranavir boosted with ritonavir in haemophilic patients. Haemophilia 2008; 14(1): 140–141.

42. Modi M, Mochan A, Modi G. Management of HIV-associated focal brain lesions in developing countries. QJM 2004; 97(7): 413–421.

43. Wasay M, Kheleani KB, Moolani MK, Zaheer J, Pui M, Hasan S et al. Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma. J Neuroimaging 2003 13(3): 240–247.

44. Corti M, Villafañe M, Negroni R, Arechavala A, Maiolo E. Magnetic resonance imaging findings in AIDS patients with central nervous system cryptococcosis. Rev Iberoam Micol 2008; 25(4): 211–214.

45. Berger JR, Sheremata WA, Resnick L, Atherton S, Fletcher MA, Norenberg M. Multiple sclerosis-like illness occurring with human immunodeficiency virus infection. Neurology 1989; 39(3): 324–329.

46. Coban A, Akman-Demir G, Ozsut H, Eraksoy M. Multiple sclerosis-like clinical and magnetic resonance imaging findings in human immunodeficiency virus positive-case. Neurologist 2007; 13(3): 154–157.

47. Durán E, Gálvez J, Patrignani G, Izquierdo G. Multiple sclerosis-like illness in a HIV-1 patient. J Neurol 2004; 251(9): 1142–1144.

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