11/16/11
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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
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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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- Fall '11
- PeterIngmire
- hiv disease, • Nutritional disorders, • Women progress
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