title: Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy.
abstract: OBJECTIVE
  Neurologic complications of HIV infection are unfortunately common, even in the era of effective antiretroviral treatment (ART). The consulting neurologist is often asked to distinguish among neurologic deterioration due to opportunistic infection (OI), immune reconstitution, or the effect of the virus itself, and to comment on the role of immunomodulatory agents in patients with HIV infection. Additionally, as successful virologic control has extended the life span of patients with HIV infection, neurologists are called upon to manage long-term complications, such as neurocognitive disorders and peripheral neuropathy.
  
  
  RESULTS
  Despite the use of ART, significant numbers of patients continue to be affected by HIV-associated neurocognitive disorders, although with milder forms compared to the pre-ART era. Regimens of ART have been ranked according to CNS penetration and are being studied with regard to neuropsychological outcomes. Nucleoside analogs with the greatest potential for peripheral neurotoxicity are no longer considered first-line agents for HIV treatment. Efavirenz, a non-nucleoside reverse transcriptase inhibitor, has the greatest frequency of neurologic side effects among newer ART regimens. The spectrum of clinical manifestations of immune reconstitution inflammatory syndrome (IRIS) continues to grow, including IRIS without underlying OI. A greater understanding of pathophysiology and risk factors has shown that while HIV should be treated early to prevent severe immunocompromise, delayed initiation of ART may be helpful while treating OIs.
  
  
  CONCLUSIONS
  This article reviews the neurologic complications of HIV infection, or its treatment, most commonly encountered by neurologists.
authors.affiliation: National Institutes of Health, Building 10, 6-5700, Bethesda, MD 20892, USA. mattes1@ninds.nih.gov
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Kranick
authors.forename: Avindra
authors.initials: A
authors.lastname: Nath
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000821:virology; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000188:drug therapy / Q000821:virology; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy / Q000821:virology; D020807:Central Nervous System Parasitic Infections / Q000188:drug therapy / Q000821:virology; D020805:Central Nervous System Viral Diseases / Q000188:drug therapy / Q000821:virology*; D003072:Cognition Disorders / Q000188:drug therapy / Q000821:virology; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006566:Herpesviridae Infections / Q000188:drug therapy / Q000821:virology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy / Q000821:virology; D007155:Immunologic Factors / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000188:drug therapy / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D019380:Anti-HIV Agents; D000927:Anticonvulsants; D007155:Immunologic Factors; D018894:Reverse Transcriptase Inhibitors