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Section 9 slides - Possible causes of neurological disease...

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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
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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
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