Neurological disorders in HIV in Africa: a review

Abstract

BackgroundNeurological disorders in HIV infection are a common cause of morbidity and mortality. The aim of this paper is to provide a narrative overview of up to date information concerning neurological disorders affecting HIV infected persons in Africa.MethodsSeminal research concerning neurological disorders among HIV-infected adults in sub-Saharan Africa from prior to 2000 was combined with an in-depth search of PubMed to identify literature published from 2000 to 2017. The following Mesh terms were used. “Nervous System Diseases” “HIV Infections” and “Africa South of the Sahara” and “Seizures” or “Spinal Cord Diseases” or “Peripheral Nervous System Diseases” or “AIDS Dementia Complex” or “Opportunistic Infections” or “Immune Reconstitution Inflammatory Syndrome” or “Stroke”. Only those articles written in English were used. A total of 352 articles were identified, selected and reviewed and 180 were included in the study. These included case series, observational studies, interventional studies, guidelines and reviews with metanalyses. The author also included 15 publications on the subject covering the earlier phase of the HIV epidemic in Africa from 1987 to 1999 making a total of 195 references in the study. This was combined with extensive personal experience diagnosing and treating these neurological disorders.ResultsNeurological disorders were common, typically occurring in WHO stages III/IV. These were in three main categories: those arising from opportunistic processes mostly infections, direct HIV infection and autoimmunity. The most common were those arising from direct HIV infection occurring in >50%. These included HIV-associated neurocognitive dysfunction (HAND), neuropathy and myelopathy. Opportunistic infections occurred in >20% and frequently had a 6–9-month mortality rate of 60–70%. The main causes were cryptococcus, tuberculosis, toxoplasmosis and acute bacterial meningitis. Concurrent systemic tuberculosis occurred in almost 50%.ConclusionNeurological disorders are common in HIV in Africa and the main CNS opportunistic infections result in high mortality rates. Strategies aimed at reducing their high burden, morbidity and mortality include early HIV diagnosis and anti-retroviral therapy (ART), screening and chemoprophylaxis of main opportunistic infections, improved clinical diagnosis and management and programme strengthening.

HIV-Associated CD8 Encephalitis: A UK Case Series and Review of Histopathologically Confirmed Cases

“…Globally, the largest number of individuals with HIV infection reside in sub-Saharan Africa. Recent reviews of HIV-related brain disease in Africa do not describe cases of HIV-CD8E ( 29 , 30 ), however HIV-CD8E may be under-recognized and under-reported in this setting. Between 2018 and 2020, SN has observed several clinico-radiologically-diagnosed cases of HIV-CD8E among Black African ART-treated patients in Cape Town, South Africa (personal observations, unpublished).…”

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

“…In addition, with drug‐resistant TB, various second‐line treatments, such as cycloserine, ethionamide, fluoroquinolones and newer drugs (such as linezolid), can cause PN (26%) 6 . HIV is associated with PN 7 , and the concomitant treatment of HIV and multidrug resistant‐TB can result in PN in ~50% of patients 8 . Long‐term survivors of childhood acute lymphoblastic leukemia can have a high prevalence of PN and in a Malaysian series of 101 acute lymphoblastic leukemia survivors treated with vincristine, 26.7% had an abnormal clinical Total Neuropathy Score, and 68.3% had electrophysiological evidence of neuropathy 9 .…”

Ten-year plateau phase in human immunodeficiency virus induced motor neuron disease upon antiretroviral therapy: a first case from Eastern Africa.

“…fold. 8,9 Since early on in the HIV epidemic, multiple cases of HIV-ALS have been described. [10][11][12][13][14][15][16] HIV-ALS can cause a clinical presentation compatible with sporadic ALS (sALS).…”