Opportunistic infections and neoplasias, which led to the identification and characterisation of AIDS, are the most common manifestations of this disease. The present review gives a comprehensive presentation of the current knowledge on the opportunistic infectious agents concerned and on the resulting clinical pictures with special emphasis on neuropsychiatric symptomatology. Prior to the development of the full syndrome of AIDS, a number of intermediate steps can be observed, the most important of which is persistent generalised lymphadenopathy (PGL). For all stages of the disease, problems of clinical course, risk of transmission, and prognosis are discussed in detail. Neuropsychiatric manifestations of AIDS can occur as sequelae of opportunistic infections, AIDS-associated neoplastic processes or of the retrovirus infection itself. In a number of cases neuropsychiatric manifestations are the presenting symptoms of the disease. Since neuropsychiatric symptoms such as organic brain syndrome or dementia represent crucial determinants of prognosis, they have to be considered in the planning of long-term care for the AIDS patient. Due to certain epidemiological features such as an exponential increase of its incidence during the last few years and the preferential occurrence in homosexuals and drug addicts, AIDS has brought about a number of important psychosocial effects. Since an efficient chemotherapy is not yet available and long-term prognosis is poor, AIDS patients often become isolated, and even medical professionals avoid to have contact with them. To reduce an exaggerated fear of being infected by the AIDS virus and to gain the competence for realistic assessment of the remaining risks, it is necessary to acquire a profound knowledge of the disease.
AIDS is a transmissible immunodeficiency syndrome which has first been observed less than a decade ago and since that time has spread in an epidemic manner. Usually it manifests itself by opportunistic infections and/or neoplasias. After courses of a few years, approximately 100% of cases have a lethal outcome. Sometimes, neuropsychiatric disturbances are the presenting symptoms and signs of AIDS. One of the first important observations was, that certain behavioural patterns such as homosexuality and intravenous drug abuse were apparently associated with a high risk for acquiring AIDS. The occurrence of AIDS in a number of haemophiliacs and recipients of blood transfusions suggested an important role of the haematogenous route of transmission. Not more than two years after the first clinical reports on AIDS a retrovirus was identified as the etiological agent. On the basis of different criteria this retrovirus can be classified as a slow virus. Subsequently, virological tests were developed which allowed an early diagnosis of this viral infection, even prior to the evolution of clinical symptoms. Immunological features of this new syndrome include disturbances of cellular as well as humoral immune functions. As we have no effective chemotherapy for AIDS and the successful development of a vaccine is delayed by a number of virological problems, it is of special importance to prevent transmission of the disease.
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