Neurologic signs and symptoms frequently manifest in acute HIV infection.
To determine the incidence, timing, and severity of neurologic findings in acute HIV infection (pre-antibody seroconversion), as well as persistence with combination antiretroviral therapy (cART).



Participants identified with acute HIV were enrolled, underwent structured neurologic evaluations, immediately initiated cART, and were followed with neurologic evaluations at 4 and 12 weeks. Concurrent brain MRIs and both viral and inflammatory markers in plasma and CSF were obtained.



Median estimated HIV infection duration was 19 days (range 3-56) at study entry for the 139 participants evaluated. Seventy-three participants (53%) experienced one or more neurologic findings in the 12 weeks after diagnosis, with one developing a fulminant neurologic manifestation (Guillain-Barré syndrome). A total of 245 neurologic findings were noted, reflecting cognitive symptoms (33%), motor findings (34%), and neuropathy (11%). Nearly half of the neurologic findings (n = 121, 49%) occurred at diagnosis, prior to cART initiation, and most of these (n = 110, 90%) remitted concurrent with 1 month on treatment. Only 9% of neurologic findings (n = 22) persisted at 24 weeks on cART. Nearly all neurologic findings (n = 236, 96%) were categorized as mild in severity. No structural neuroimaging abnormalities were observed. Participants with neurologic findings had a higher mean plasma log10 HIV RNA at diagnosis compared to those without neurologic findings (5.9 vs 5.4; p = 0.006).



Acute HIV infection is commonly associated with mild neurologic findings that largely remit while on treatment, and may be mediated by direct viral factors. Severe neurologic manifestations are infrequent in treated acute HIV.
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT. joanna.hellmuth@ucsf.edu.
Joanna
J
Hellmuth
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
James L K
JL
Fletcher
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Victor
V
Valcour
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Eugène
E
Kroon
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Jintanat
J
Ananworanich
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Jintana
J
Intasan
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Sukalaya
S
Lerdlum
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Jared
J
Narvid
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Mantana
M
Pothisri
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Isabel
I
Allen
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Shelly J
SJ
Krebs
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Bonnie
B
Slike
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Peeriya
P
Prueksakaew
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Linda L
LL
Jagodzinski
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Suwanna
S
Puttamaswin
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Nittaya
N
Phanuphak
From the Departments of Neurology (J.H., V.V.), Radiology (J.N.), and Epidemiology and Biostatistics (I.A.), University of California, San Francisco; SEARCH (J.L.K.F., E.K., J.I., P.P., S.P., N.P.), Thai Red Cross AIDS Research Centre, Bangkok, Thailand; US Military HIV Research Program (J.A., S.J.K., B.S., L.L.J.), Walter Reed Army Institute of Research, Silver Spring; Henry M. Jackson Foundation for the Advancement of Military Medicine (J.A., S.J.K., B.S.), Bethesda, MD; Department of Radiology (S.L., M.P.), Chulalongkorn University, Bangkok, Thailand; and Department of Neurology (S.S.), Yale University, New Haven, CT.
Serena
S
Spudich
D000208:Acute Disease; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D001921:Brain / Q000000981:diagnostic imaging; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity; D012720:Severity of Illness Index; D013997:Time Factors
D044966:Anti-Retroviral Agents; D015415:Biomarkers