Influence of Neurologic Manifestations of Primary Human Immunodeficiency Virus Infection on Disease Progression

Boufassa, Faroudy; Bachmeyer, Claude; Carré, N; Deveau, Christiane; Persoz, Anne; Jadand, C.; Séréni, D.; Bucquet, D.

doi:10.1093/infdis/171.5.1190

Cited by 65 publications

(31 citation statements)

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“…33 Individuals with neurological manifestations of primary HIV infection should initiate cART as these manifestations are associated with accelerated progression of HIV. 34 Initiation of cART during primary infection may have long-term benefits by reducing the latent viral reservoir, lowering the viral set point and preserving immune function and can potentially reduce transmission. 35 Although data on the effect of cART in reducing the risk of severe complications of primary HIV infection are lacking, we believe that patients presenting with CNS symptoms as part of a primary infection should be offered .500,000 …”

Section: Discussionmentioning

confidence: 99%

Encephalitis in primary HIV infection: challenges in diagnosis and treatment

Helleberg

Kirk

2013

Int J STD AIDS

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We report a case of primary HIV encephalitis, which initially presented as acute psychosis. Magnetic resonance imaging of the brain was suggestive of vasculitis and multiple infarctions, whereas a brain biopsy after six weeks of symptoms showed HIV encephalitis with microglial nodules, but no signs of vasculitis. We review previous reported cases and radiological findings in HIV encephalitis and discuss the role of antiretroviral therapy and steroids in its management.

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Section: Discussionmentioning

confidence: 99%

Encephalitis in primary HIV infection: challenges in diagnosis and treatment

Helleberg

Kirk

2013

Int J STD AIDS

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“…Approximately 20% of individuals with primary human immunodeficiency virus type 1 (HIV-1) infection syndrome have symptoms of viral meningitis (2,5,23,38). HIV-1 infection of the brain occurs early, whereas HIV-associated dementia (HAD) generally develops only in late-stage HIV-1 disease (Ͻ50 CD4 cells/l) (23).…”

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confidence: 99%

Phylodynamic Analysis of Human Immunodeficiency Virus Type 1 in Distinct Brain Compartments Provides a Model for the Neuropathogenesis of AIDS

Salemi

Lamers²,

Yu³

et al. 2005

J Virol

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"Phylodynamic" analysis combines various statistical procedures that can be used to correlate the epidemiological and evolutionary behavior of viral pathogens with the immune system of the host. We utilized this approach to examine human immunodeficiency virus type 1 (HIV-1) gp120 envelope DNA sequences (V1, V2, and V3) isolated from different brain compartments of a T-cell-depleted patient diagnosed with severe HIVassociated dementia at the time of death. In agreement with previous reports, phylogenetic analysis showed distinct virodemes but also revealed a significant amount of viral gene flow among different brain compartments. Local-molecular-clock analysis showed that HIV-1 meninges and temporal lobe subpopulations evolve about 30 and 100 times faster, respectively, than the other viral populations in the brain. However, maximum likelihood codon-based substitution models did not detect any site under significant positive selective pressure, and the main cause of HIV-1 genetic variation appeared to be random genetic drift. Therefore, the higher evolutionary rate in the meninges and temporal lobe could be due to an enhanced infection/expansion rate of macrophages as a consequence of the immune system failure. In conclusion, in this case study, viral infection in the brain progressed with a nonspecific genetic evolution, recurrent migration events, and an expansion of macrophage-tropic sequences. The data suggest that after immune failure newly produced viral variants, which would be rapidly cleared under normal conditions, begin to productively infect macrophages in a "selfamplifying" cycle of infection/inflammatory response that could be at the origin of HIV-associated dementia.

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“…In most studies of risk factors for progression, the endpoint is the onset of AIDS. Epidemiological studies have suggested a shorter AIDS incubation period in patients with symptomatic primary infection (SPI) 3,4 and among homosexual patients (relative to heterosexuals 5 and haemophiliacs 6 ). To date, age at infection is the most widely recognized risk factor for progression to AIDS.…”

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confidence: 99%

Influence of age at infection on human immunodeficiency virus disease progression to different clinical endpoints: the SEROCO cohort (1988- 1994). The Seroco Study Group

Bélanger

Meyer²,

Carré³

et al. 1997

International Journal of Epidemiology

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Method. The influence of age at infection on progression of human immunodeficiency virus (HIV) disease to different clinical endpoints was studied among 393 HIV-seropositive adults selected from the French SEROCO cohort; follow-up lasted from January 1988 to November 1994. Selected patients had a known date of infection and were enrolled shortly after seroconversion. Age-associated risk ratios (RR) were estimated using the Cox model (age fitted as a continuous variable and RR expressed for each 10-year increment after adjustment for symptomatic primary infection and sexual preference). Results. Age had a weak influence on progression from the date of infection to the first category B event (crude RR = 1.15; adjusted RR = 1.09; 95% confidence interval [CI] : 0.89-1.36) but a marked influence on progression from the first category B to the first category C event (crude RR = 1.95; adjusted RR = 1.97; 95% CI : 1.37-2.79). Similar results were obtained after adjustment for the CD4 + cell count at enrolment. A qualitative CD4 + cell defect could explain the influence of age, but this remains to be confirmed. Conclusion. Age at infection should be included in the definition of CD4 + cell count thresholds for clinical management and treatment initiation. Risk factors for progression should be assessed according to the different clinical endpoints.

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Influence of Neurologic Manifestations of Primary Human Immunodeficiency Virus Infection on Disease Progression

Cited by 65 publications

References 0 publications

Encephalitis in primary HIV infection: challenges in diagnosis and treatment

Encephalitis in primary HIV infection: challenges in diagnosis and treatment

Phylodynamic Analysis of Human Immunodeficiency Virus Type 1 in Distinct Brain Compartments Provides a Model for the Neuropathogenesis of AIDS

Influence of age at infection on human immunodeficiency virus disease progression to different clinical endpoints: the SEROCO cohort (1988- 1994). The Seroco Study Group

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