Neurological Complications of HIV
HIV is the virus that causes AIDS. HIV weakens and slowly destroys the body’s immune system, leaving you vulnerable to life-threatening complications from an infection or the flu.
As HIV and AIDS battle your immune system, your central nervous system is also affected. HIV and AIDS both cause a number of neurological complications, particularly if HIV goes or progresses to AIDS.
Today, antiretroviral medications—when taken correctly and promptly—help to slow down the progression of HIV and help delay the onset of or decrease the risk of progression to AIDS. Controlling HIV can also reduce your risk for neurological complications of HIV.
Facts about HIV/AIDS
HIV is a virus that's sexually transmitted, but can also be passed from mother to baby and person to person by sharing a contaminated needle or through transfusion of contaminated blood. Untreated, the virus will continue to replicate in the body, becoming more and more advanced. Advanced HIV becomes AIDS, which often results in a number of neurological complications as the body becomes more damaged.
HIV doesn't seem to take over the cells in your nervous system, but it does cause significant inflammation in the body. This inflammation can damage the spinal cord and brain and prevent your nerve cells from working the way that they should.
Neurological complications may result not only from damage caused by the virus itself, but also from other side effects of HIV and AIDS, such as cancers that are associated with these diseases. Some of the drugs used to treat HIV and AIDS can also cause neurological complications while attempting to control the rapid spread of the virus. Certain genetic factors can influence the risk of neurological side effects from HIV medications.
Neurological complications don't usually set in until HIV is advanced, typically when someone has AIDS. About half of adults with AIDS suffer from neurological complications related to HIV.
Types of neurological complications of HIV
HIV can cause many different conditions that affect the nervous system:
Dementia. When HIV becomes very advanced, HIV-associated dementia or AIDS dementia complex can occur. These disorders impair cognitive function, which means that you may have trouble thinking, understanding, and remembering. This type of dementia can be life-threatening, but can often be prevented when antiretroviral drugs are taken correctly.
Viral infections. HIV can increase your risk for several viral infections that strike the nervous system. Cytomegalovirus infections can negatively affect cognitive function, physical control (such as the use of legs and arms and bladder control), vision and hearing, and your respiratory system, causing problems like pneumonia. People with AIDS are also likely to develop a herpes virus infection such as shingles, inflammation in the brain, and inflammation in the spinal cord. Another condition, progressive multifocal leukoencephalopathy (PML) is also caused by a virus. PML is aggressive and dangerous but in some circumstances, it can be controlled with antiretroviral medications.
Fungal and parasitic infections. Cryptococcal meningitis is caused by a fungus and leads to serious inflammation of the spinal cord and brain. A parasite can cause an infection called toxoplasma encephalitis, which often leads to confusion, seizures, and extremely painful headaches. Both of these infections can be life-threatening.
Neuropathy. HIV can cause damage to nerves throughout the body, resulting in significant pain or weakness, known as neuropathy. Neuropathy is most common in people with advanced HIV.
Vacuolar myelopathy. This condition occurs when tiny holes develop in the fibers of the nerves of the spinal cord. It causes difficulty walking, particularly as the condition gets worse. It's common in people with AIDS who aren't receiving treatment and also in children with HIV.
Psychological conditions. People with HIV or AIDS often develop anxiety disorders and suffer from depression. They may also experience hallucinations and significant changes in behavior.
Lymphomas. Tumors called lymphomas often strike the brain of people with HIV. They're often related to another virus, similar to the herpes virus. Lymphomas can be life-threatening, but good management of HIV can make treating lymphomas more successful.
Neurosyphilis. If an HIV-infected person also has syphilis that goes untreated, it can quickly progress and damage the nervous system. It can cause the nerve cells to break down and lead to loss of vision and hearing, dementia, and difficulty walking.
Once HIV begins affecting your immune system, it can cause many different symptoms. HIV-related neurological complications may lead to:
Suddenly forgetting things all the time or acting confused
Feeling of weakness that keeps getting worse
Changes in behavior
Problems with balance and coordination
Changes in your vision
Losing feeling in your legs or arms
Mental health problems like anxiety and depression
Although a blood test can diagnose HIV and AIDS, a number of other diagnostic tests are needed to look at the different parts of the nervous system and diagnose neurological problems. Tests often include:
An electromyography to measure the electrical activity of the muscles and nerves
Biopsy to analyze a sample of tissues and help identify tumors in the brain or inflammation in the muscles
Magnetic resonance imaging (MRI), which uses radio waves and powerful magnets to image the brain structures. This is the most powerful conventional imaging tool and can detect brain inflammation, many infections, tumors, strokes, and tissue destruction within the brain and spinal cord.
Sample of cerebrospinal fluid to look for infections, bleeding, or other abnormalities affecting the spinal cord or brain
CT scan, which uses X-rays to reconstruct a three-dimensional image of the brain. This test is faster and less expensive, but provides less detail than an MRI scan.
Antiretroviral drugs are used to stop HIV from replicating and spreading throughout the body and to help reduce the risk that it will cause damage to the nervous system.
Specific neurological conditions and complications are treated differently. Cancer may be treated with chemotherapy and radiation, and bacterial infections need antibiotics. Certain medications may help manage viral infections, and medications to manage pain can help alleviate nerve pain. Counseling and medications, including antidepressants, may be used to manage some of the psychological conditions associated with HIV.
Following all of your doctor's recommendations, especially taking all antiretroviral medications exactly as prescribed, can help control HIV and prevent its progression. Suppressing the virus with medications can help prevent damage to the body, including nervous system damage and neurological complications.
Living a healthy lifestyle can help you better control HIV and prevent the progression to AIDS. Eating a healthy diet and maintaining a healthy body weight, exercising regularly, practicing safe sex, and following your medication regimen are all important steps in managing HIV.