CLINICAL MANIFESTATIONS OF HIV-ASSOCIATED CENTRAL NERVOUS SYSTEM LESIONS AND THE EFFECTS OF ANTIRETROVIRAL THERAPY ON THEM
DOI:
https://doi.org/10.11603/1681-2727.2020.2.11288Keywords:
central nervous system, HIV-associated lesions, clinical pictureAbstract
The aim of the work. Symptoms of nervous system damage manifest in different cases differently: by the predominant involvement of the brain substance; spinal cord; meninges; peripheral parts of the nervous system in the process. The spectrum of disorders is wide and not specific to the HIV infection. It is registrated the cognitive impairment (memory, intelligence, learning), disorders of consciousness and attention, emotional and behavioral disorders up to severe CNS damage called HIV-associated dementia. The neurological manifestations of AIDS are divided into primary and secondary. Primary lesions are associated with the direct harmful effects of the virus, autoimmune processes, neurotoxic effects of antiretroviral therapy. At the same time the secondary ones are caused by a progressive immune defect and the joining of opportunistic infections. Primary lesions are divided into early lesions: AIDS dementia (HIV-associated encephalopathy followed by dementia or AIDS dementia complex); acute early HIV encephalitis; meningitis or meningoencephalitis; vascular neuroAIDS; and later ones: vacuolar myelopathies like ascending or transverse myelitis; peripheral nervous system lesions in the form of symmetric sensory distal polyneuropathy, chronic inflammatory demyelinating polyneuropathy, acute inflammatory demyelinating polyneuropathy by type of Guillain-Barré syndrome, encephalomyelopolyneuropathy, ALS syndrome. Currently, all HIV-related CNS lesions are united under the title «HIV-associated neurocognitive disorders».
Early administration of antiviral therapy is a deterrent effect to the pathogenic impact of HIV on CNS function. However, in order to optimize the regimen it is advisable to determine the drug resistance of the virus in CSF and the viral load of the cerebrospinal fluid. However, the results of the study of the correlation between the amount of HIV in CSF and blood plasma differ: some researchers find the relationship, others find no statistically significant correlation between these indicators. It is obvious that it is necessary to select ART regimens with good penetration through the blood-brain barrier to ensure sufficient concentration of drugs and stop viral replication in CNS cells.
Accordingly, clinical and laboratory aspects require additional research of nervous system lesions in HIV infection. Clinical informativeness of virological CSF tests for assessment of the severity of HIV-associated CNS lesions has no evidence base. There are no registered test systems in the world for assessing HIV load in CSF. Furthermore these diagnostic methods are not used in the clinical practice.
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