How Are Neurological Complications Of Hiv Treated
Antiretroviral medicines are used to stop HIV from replicating and spreading throughout the body. They are also used to help lower 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. Bacterial infections need antibiotics. Certain medicines may help with viral infections or nerve pain. Counseling and medicines, including antidepressants, may be used to handle some of the mental health problems linked to HIV.
Opportunistic Illnesses In The Brain
Most of the opportunistic pathogens that strike people with impaired immune function can infect the brain. Below is a description of several illnesses that primarily or frequently involve the central nervous system . Other opportunistic illnesses less commonly linked to brain disease include histoplasmosis, coccidioidomycosis, aspergillosis, and human herpesvirus 6 .
In addition, many pathogens that are not traditionally classified as opportunistic and do not normally cause brain disease may do so in the setting of advanced immune suppression, including Staphylococcus, Streptococcus, Salmonella, herpes simplex virus, varicella zoster virus, Treponema pallidum , and Plasmodium .
Cryptococcal meningitis : inflammation of the membranes surrounding the brain caused by the yeast-like fungus Cryptococcus neoformans. Symptoms may include headache, fever, nausea, and confusion altered mental state may result from increased pressure within the skull and altered glucose levels. CM usually occurs among people with advanced immunosuppression and is seldom seen in those on effective combination ART. Treatment involves potent initial therapy typically including the antifungal drug amphotericin B, followed by maintenance therapy with an antifungal such as fluconazole until a patient achieves sustained immune recovery on ART .
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Neurological Complications Associated With Hiv Infection
People living with HIV can frequently suffer from HIV-associated neurocognitive disorders . These disorders include three categories: asymptomatic neurocognitive impairment , mild neurocognitive disorder , and HAD . ANI, the mildest form of HAND is defined by substandard performance in at least two of the so-called cognitive areas, which include fine movement, fluency, executive functions and memory, when individuals are tested for such neurocognitive abilities. By definition, no impairment with daily functioning should be observed in the individual. While often these mild impairments, despite being detected by the aforementioned tests, can pass unnoticed by the affected individual, ANI is associated with an increased risk for symptomatic decline . Therefore, early detection is important for proper management. The second form of HAND, MND, involves substandard performance in at least two cognitive areas, similar to ANI, but with the addition of, at least mild, interference with daily functioning. Lastly, HAD is the most severe form of HAND. HAD is characterized by a worse performance in at least two of the aforementioned cognitive areas and below-average performance in neuropsychological tests. Marked impairment in daily activities should be found too . Besides these primary HAND, secondary cognitive limitations may also ensue, due to other factors.
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When Hiv Infects The Brain
A new study reports that the virus can infiltrate the central nervous system within months of infection.
Just over 30 years ago, an international group of scientists discovered the HIV virus. While much progress has been made since the early days of the epidemic , HIV and AIDS remain a leading cause of death worldwide, and rank as the number one cause of death both in Africa and among women of reproductive age. A cure has yet to be found, though every so often headlines contain the word hope.
A study published Thursday in the online journal PLOS Pathogens gives reason for pause, showing that HIV can behave more insidiously than previously seen. Researchers at the Yale School of Medicine and the University of North Carolina have found that the virus can settle in peoples brains as early as four months after infection. In turn, HIV in the brain can genetically mutatedifferentiating itself from the type circulating in the bloodwhich means that certain drugs used to treat the virus may not work as well in the central nervous system as they do in other parts of the body. Over time, untreated HIV can cause negative neurological and mental-health effects, such as brain swelling and a form of dementia.
Theres also a concern that HIV in the brain could migrate back into the blood, even if its been eradicated there, Spudich says. Thats the $65 million question. Its definitely theoretically possible.
Hiv Effects On The Kidneys
High blood pressure and diabetes are both related to HIV, and both are major causes of kidney disease. The healthy diet and exercise habits that are good for your heart will help keep your blood pressure and blood sugar under control. That helps protect your kidneys, too.
Some HIV medications can damage your kidneys. If you already have kidney problems, your doctor may want to avoid those drugs or keep a close eye on their effects.
Your doctor will need to check your kidneys regularly because you might not notice the signs of kidney disease.
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How Does Chronic Hiv Affect The Body
The chronic HIV stage is known as the latent or asymptomatic stage. During this stage, a person usually wont have as many symptoms as they did during the acute phase. This is because the virus doesnt multiply as quickly.
However, a person can still transmit HIV if the virus is left untreated and they continue to have a detectable viral load. Without treatment, the chronic HIV stage can last for many years before advancing to AIDS.
Advances in antiretroviral treatments have significantly improved the outlook for people living with HIV. With proper treatment, many people who are HIV-positive are able to achieve viral suppression and live long, healthy lives. Learn more about HIV and life expectancy.
A normal CD4 count ranges from approximately 500 to 1,600 cells per cubic millimeter of blood in healthy adults, according to HIV.gov.
A person receives an AIDS diagnosis when they have a CD4 count of fewer than 200 cells/mm3.
A person may also receive an AIDS diagnosis if theyve had an opportunistic infection or another AIDS-defining condition.
People with AIDS are vulnerable to opportunistic infections and common infections that may include tuberculosis, toxoplasmosis, and pneumonia.
People with weakened immune systems are also more susceptible to certain types of cancer, such as lymphoma and cervical cancer.
The survival rate for people with AIDS varies depending on treatment and other factors.
Pathology And Pathogenesis Of Hiv Encephalitis
During the later stages of HIV infection, a subset of patients experience nervous system disease. Peripheral macrophage infiltration into brain is a widely observed component of HIV encephalitis . Clinical-pathologic investigation has shown that proliferation and immune activation of infiltrated and resident brain MP correlates better with HAD progression than does the CNS viral load . Perivascular and parenchymal brain macrophages fuse with one another and with resident microglia to form multinucleated giant cells . Pathological signs of a giant cell encephalitis can be found in cortex but preferentially affects subcortical white matter, deep white tracts and basal ganglia. Other histologic findings include microglial nodules, neuronal dropout, diffuse myelin pallor and reactive astrogliosis. Myelin pallor of HIV encephalitis represents disruption of the neuron-oligodendrocyte interaction. The HIV encephalitic brain may appear atrophic with ventricular dilatation but is otherwise unremarkable. Interestingly, the pathological features of HIV-encephalitis do not always correlate with clinical neurologic deficits.
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How Are These Disorders Diagnosed
Based on an individuals medical history and findings from a general physical exam, a physician will conduct a thorough neurological exam to assess various functions: motor and sensory skills, nerve function, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior. The physician may order laboratory tests andone or more of the following procedures to help diagnose neurological complications of AIDS.
Brain imaging can reveal signs of brain inflammation, tumors and CNS lymphomas, nerve damage, bleeding, white matter irregularities, and other abnormalities. Several painless imaging procedures are used to help diagnose neurological complications of AIDS.
- Computed tomography uses x-rays and a computer to produce two-dimensional images of bone and tissue to show inflammation, certain brain tumors and cysts, brain damage from head injury, and other abnormalities. It provides more details than an x-ray alone.
- Magnetic resonance imaging uses a computer-generated radio waves, and a powerful magnetic field to produce either a detailed three-dimensional picture or a two-dimensional slice of body structures, including tissues, organs, bones, and nerves. It does not use the ionizing radiation that an x-ray does and provides a better look at tissue located near bone.
What Happens In Hiv
People with HAD can have changes in behavior, mood, movement, and/or thinking skills. A person with HAD can have symptoms that vary, and they might be better one day and worse the next. Some people have more trouble with thinking changes such as attention, memory, and concentration. For example, a person with HAD may have trouble following a conversation, remembering phone numbers and appointments, or difficulty understanding questions they are being asked. These problems are often the first to become apparent to the individual and their family members.
In later stages of HIV, movement and behavior symptoms may develop or become worse. People with HAD may begin to have weakness in their legs or difficulty balancing. Mood and behavior problems may also develop later. For example, people with HAD may become depressed, irritable, or uninterested.
A person with HAD can live many years with the disease, although this can vary from person to person. cART may prevent or delay the onset of HAD.
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What We Know About How Hiv Affects The Brain
Patients with HIV are living longer. How does their condition affect the cognitive decline that comes with aging?
Whether HIV is directly associated with neurocognitive decline is uncertain, but theres substantial evidence suggesting that it indirectly manifests in poorer neurocognitive outcomes.
HIV invades the central nervous system very early on in infection, according to Shibani Mukerji, MD, PhD, of the Department of Neurology at Massachussetts General Hospital.
Within days of plasma viremia, HIV RNA can be detected in the cerebrospinal fluid , and this early penetration is hypothesized to set the stage for future neurocognitive impairment, Mukerji said during a presentation at IDWeek 2017 in San Diego, CA.
The central nervous system has its own unique immune surveillance, Mukerji explained, but recent studies indicate that this immune surveillance is complimented by input from the peripheral immune system. Peripheral cells, including t-lymphocytes, enter the CNS under normal conditions, but during HIV infection and immune activation, there is a heightened trafficking of these cells, which can harbor HIV.
When an HIV infected cell enters the brain, there is a release of inflammatory cytokines and chemokines, which then attract more immune cells. There is a cycle of inflammation that is established, Mukerji said.
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Hiv Directly Impacts The Brain In The Early Stages Of The Infection Report Researchers
- Date:
- Stellenbosch University
- Summary:
- The human immunodeficiency virus directly impacts the brain in the early stages of the infection, researchers have found.
Stellenbosch University researchers have discovered that the human immunodeficiency virus directly impacts the brain in the early stages of the infection.
It has long been known that many people with HIV also experience negative cognitive symptoms, such as depression, forgetfulness, etc. However, it was unclear whether it was caused by such patients’ physical illness, or whether the HI virus had a direct effect on the brain.
“Our research shows that HIV does have an impact on the brain and that these low-grade cognitive symptoms are likely not just function loss due to patients feeling sick, tired or depressed,” says Dr Stéfan du Plessis, lead author of a series of articles about the research published in AIDS and other international journals.
Using functional magnetic resonance imaging — a type of brain scan that shows how blood flows to certain parts of the brain when someone is performing certain tasks or is experiencing certain emotions — Du Plessis and his team compared the brain activity of people with HIV to those without HIV while they performed certain tasks designed to stimulate specific regions of the brain. HIV-positive study participants were in good physical and mental health, did not abuse drugs, and had not yet started on antiretroviral treatment .
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How Does Heroin Affect The Brain & Neurotransmitters
Once the brain encounters these synthetic opioids though, it is less likely to produce its own. The more a person takes heroin, the less natural opioid the brain will produce. This affects the opioid receptors, and the risk/reward system in the brain, which is the primary pathway that uses dopamine. The brain also decreases how much dopamine, serotonin, and other neurotransmitters it produces because these are released artificially due to heroin use.
If a person is unable to take heroin when their brain needs the drug, they will experience withdrawal symptoms. Most of these symptoms feel like an intense flu, complete with aches, chills, depression, exhaustion, and nausea very strong cravings for the drug also often occur.
Cns Complications In Children
The manifestations of AIDS and its neurologic complications differ in children, whose immune and nervous systems are infected at an immature stage, whether in utero, during delivery, or postpartum. CNS complications tend to progress more rapidly in children, probably because of the inability of their immune systems to mount an appropriate T-cell, B-cell, or cytokine response to the infection.
Neurologic involvement in HIV infection is more frequent in children than in adults. It may take the form of a loss of previously acquired intellectual and motor milestones or of developmental delay. Opportunistic infections due to reactivation of dormant organisms are unusual, as children may not have been exposed yet to the responsible organisms. Distinguishing features include blood vessel calcification in the basal ganglia, large necrotizing cortical and subcortical lesions, microcephaly, and infection of astrocytes.
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How Is Hiv Treated
Treatments for HIV typically involve antiretroviral therapy. This isnt a specific regimen, but instead a combination of three or four drugs. The U.S. Food and Drug Administration has currently approved nearly 50 different medications to treat HIV.
Antiretroviral therapy works to prevent the virus from copying itself. This maintains immunity levels while slowing the progression of HIV.
Before prescribing medication, a healthcare provider will take the following factors into consideration:
- a persons health history
- the levels of the virus in the blood
HIV doesnt cause a lot of outward or noticeable symptoms until the disease has progressed. For this reason, its important to understand how HIV is transmitted and the ways to prevent transmission.
HIV can be transmitted by:
- having sex, including oral, vaginal, and anal sex
- sharing needles, including tattoo needles, needles used for body piercing, and needles used for injecting drugs
- coming into contact with body fluids, such as semen, vaginal fluid, blood, and breast milk
HIV is not transmitted by:
- breathing the same air as a person living with HIV
- getting bitten by a mosquito or other biting insect
- hugging, holding hands with, kissing, or touching a person living with HIV
- touching a door handle or toilet seat thats been used by an HIV-positive person
Keeping this in mind, some of the ways a person can prevent HIV include:
Symptoms can take years to appear, which is why its so important to get tested regularly.
What Is Hiv Encephalopathy
HIV encephalopathy is a serious complication of HIV. HIV affects many body systems, including the immune system and the central nervous system. When the virus reaches the brain, a variety of mental and intellectual problems can happen.
When an HIV infection causes the brain to swell, its called HIV encephalopathy. Other names for this are HIV-associated dementia and AIDS dementia complex. This condition can affect motor functions and cognitive abilities, and lead to dementia.
Even though the virus can enter the brain fairly soon after infection, HIV encephalopathy tends to occur in advanced HIV, making it an AIDS-defining condition.
HIV encephalopathy cant be cured, but it can be slowed or managed with treatment such as antiretroviral therapy.
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Animal Models Of Hiv Infection In The Cns
Another remarkable rodent model includes humanized mice, which are generated by implanting human tissues and/or injecting human cells into various strains of immunodeficient mice . Several types have been developed: the c-HIVE model in which HIV-infected myeloid cells are injected directly into the brains of severe combined immunodeficient mice, to see if they contribute or not to HIV-associated encephalitis the PBMC-transplanted mice, in which human peripheral blood mononuclear cells are inoculated the hematopoietic stem cells-transplanted mice and the myeloid only mouse model, to cite a few .
While murine animal models have certain limitations, such as divergent receptor sequence with humans, or differences in regional expression of cellular receptors , most of them have relatively low cost and allow for large sample size.
Animal models have proven especially useful for research on substance abuse and HIV comorbidity . For instance, animal experiments have shown evidence that the presence of HIV-1 viral proteins in the CNS increases the sensitivity and susceptibility of HIV-positive individuals to substance abuse . Continued research on the manifestation and mechanisms of neurological injury in HAND patients is needed. Animal models will be critical to help develop safe and effective therapies that reverse neuropathology and cognitive impairment .
The Endopiasmic Reticuium And Neural Apoptosis
In addition to the mitochondria, oxidative stress is also able to cause neuronal dysfunction in the Endopiasmic Reticuium . In its regular state, the ER is responsible for the synthesis, folding and transport of proteins, as well as functioning as the main store for intracellular Ca2+ . Under normal conditions, the ER releases Ca2+ for use by the mitochondria to enhance metabolite flow on the outer mitochondrial membrane and to increase ATP production however sustained release of Ca2+ from the ER can initiate calcium-dependent apoptosis via the permeabilization of the mitochondrial membrane . Changes in calcium homeostasis have been implicated with Meth-induced cellular demise, because Meth has been shown to activate calpain , a Ca2+ responsive cytosolic cysteine protease that is an important mediator of ER-dependent cell death . Further evidence for the participation of the ER in Meth-related cell death is demonstrated in the finding that apoptotic doses of Meth influence the expression of the proteins caspase-12, GRP78/Bip, and CH0P/GADD153 , proteins known to participate in ER-induced apoptosis and the ER-mediated unfolded protein response . Despite this evidence, Meth-induced ER dysfunction may play a secondary role to Meth-related oxidative stress and to increases in the BAX/Bcl-2 ratio .
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