Update HIV-Infection and Neuro-AIDS

Arendt G., Grauer O., Hahn K., Maschke M., Obermann M., Husstedt I.

Zusammenfassung

Despite very effective treatment options for HIV-infection, Neuro-Aids and neuro-cognitive disorders remain a problem. There are three stages: HIV-associated, neurocognitive impairment (ANI), mild, HIV-associated neurocognitive deficit (MNCD) and HIV-associated dementia (HAD). Antiretroviral combination therapy (cART) should take into account the CNS penetration effectiveness (CPE)-score of the antiretroviral drugs. CSF-viral load and genetic virus variants should be analysed. There are also virus-associated complications of the peripheral nervous system. Besides the classic distal symmetrical, HIV-associated polyneuropathy, immunogenic neuropathies (CIDP, AIDP) and myopathies also occur. Polyneuropathies caused by cART represent a differential diagnosis. Acquired mitochondrial toxic myopathies occur more frequently, because nowadays cART is administered over 10-20 years. Depression, a frequent psychiatric complication, is associated with poor adherence and higher viral loads, and must be treated promptly. In recent years, the prevalence of opportunistic CNS-infections has declined due to the modern antiretroviral therapy. Progressive multifocal leucoencephalopathy (PML), Toxoplasma gondii encephalitis and Cryptococcus neoformans meningitis are the most common OIs. In case of rapidly progressive disease, an immune reconstitution syndrome (IRIS) should be considered. There is currently no reliable method to differentiate PML-deterioration from IRIS-PML. Because of a significantly increased life expectancy, comorbidities become more relevant. Neopterine as a marker of macrophage activation, neurofilament light protein and total tau protein represent biomarkers for disease activity in the CNS.