Section 9 slides - Possible causes of neurological disease Neurological Disease Dementia Myelopathy Peripheral Neuropathy AIDS Dementia Complex(ADC

11/16/11 1 Neurological Disease Dementia Myelopathy Peripheral Neuropathy Possible causes of neurological disease • AIDS Dementia Complex (ADC) – direct effects of HIV infection on brain tissue – indirect effects of immune system on brain tissue • Brain OIs associated with immune suppression • Brain cancer (lymphomas) associated with immune suppression • Nutritional disorders; metabolic disorders • Drug use (recreational or Rx side effects) • Cerebrovascular problems – infarction, hemorrhage, vasculitis • Psychological factors Possible causes of ADC • Infected neural cells and Mø’s produce toxins – nef and rev proteins – proteolytic enzymes – quinolinic acid • HIV infection of endothelial cells àฏ inflammation • Indirect killing of neurons by gp120 • Decreased ATP àฏ decreased brain metabolism • Tat protein destroys brain tissue • Infection by CMV or JC viruses • Increased Mø activity • Increased age àฏ greater chance of progression Constitutional Disease Fever persisting more than one month, or diarrhea persisting more than one month, or weight loss greater than 10% baseline Possible reasons for weight loss • CTL tissue destruction • TNF-induced cachexia • HIV on GI tract – acute esophageal ulcer – malabsorptive diarrhea – inflammation of the colon (colitis) • Diarrheal OIs • KS of the intestinal tract • Oral/esophageal lesions cause eating discomfort Possible reasons for weight loss • Swollen glands • Dysgeusia • Effect of HIV disease – Dementia – Anxiety – Depression – Anorexia – Nausea/vomiting – Lack of strength or money

This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document

11/16/11 2 Treatments • Anti-TNF (thalidomide & pentoxyphilline) • hGH • Steroids • Exercise/weight training (limited) • Improved health OIs • Have caused 90% of AIDS deaths (1998) but ⇓ 4- fold since ARTs • Diagnosis depends on degree or place of infection • Some are predictive of progression to AIDS • Most are not severely contagious • TB and syphilis are contagious; can be reactivated Protozoal infections (simple organisms) • Toxoplasmosis – encephalitis, pneumonia, orchitis – cats, rodents, carnivores • Cryptosporidiosis – severe diarrhea, respiratory problems – farm animals • Isosporiasis – diarrhea, disseminated • Microsporidium – diarrhea • Acanthamoeba – sinuses, skin Viral Infections • Herpes simplex virus I and II • Cytomegalovirus – disseminated, adrenal glands, GI tract, CNS, eyes – can cause blindness • Epstein barr virus – CNS Lymphoma, oral hairy Leukoplakia, lymphoid interstitial pneumonia in children • Papovaviruses – Human papilloma virus (cervical, penile and anal warts/cancer) – JC papovavirus (Progressive Multifocal Leukoencephalopathy = PML) Fungal infections • Pneumocystis jiroveci (pneumonia) – most common cause of AIDS death in the US • Candidiasis (Candida albicans ) – oral, esophageal, vaginal, disseminated • Cryptococcosis (meningitis) – pigeons • Histoplasmosis (disseminated) – birds, bats •