ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 36 of 45
JMBS 2018, 3(3): 200–208
Medicine. Reviews

Diseases of the Central Nervous System in HIV-Infected Patients

Yevstihnieiev I. V.

The purpose of the survey is to conduct differential diagnostics of neurological manifestations of HIV infection, to evaluate the methods of laboratory confirmation of the etiological role of inflammation pathogens of the membranes and encephalitis, diseases with symptoms of volume formation of the central nervous system (hereinafter – CNS), lumbar puncture, immunoassay and immunocomatographic analyzes. Material and methods. The study showed that the greater was the degree of immunity in HIV-infected patients, the bigger was the number of opportunistic infections that could affect the central nervous system with the presence of long-term headache. It was also determined that in patients with T-helper cells, more than 200 cells in 1 μl were initially excluded as causes of headache sinusitis, headache, migraine, primary and metastatic brain tumors, meningitis, and with the number of T helper cells less than 200 cells per 1 μl the risk of opportunistic infections was significantly increased. Taking into account the symptoms of the central nervous system, it was noted during the examination, to which process they were more common: diffuse CNS damage with clinical manifestations similar to meningitis or encephalitis, or volume formation of the CNS. Results and discussion. According to the differential diagnosis of the disease there were 2 groups: 1) with clinical manifestations of meningitis or encephalitis (tuberculous meningitis, cryptococcal meningitis, HIV-dementia syndrome, cytomegalovirus ventriculoencephalitis, neurosyphilis); 2) a disease with symptoms of volumetric education (primary lymphoma of the CNS, toxoplasmosis, progressive multifocal leukoencephalopathy). If during the MRI or CT the volume formation in the brain was not found, then the diagnosis of primary lymphoma of the CNS, progressive multifocal leukoencephalopathy, toxoplasmosis was less probable. It is necessary to exclude other infections that can cause meningitis, encephalitis (tuberculosis, cryptococcus, neurosyphilis, cytomegalovirus infection). The attention was paid to the significance of the study of spinal fluid in a differential diagnosis of opportunistic infections. Patients with HIV-dementia appeared to be complaining about memory and walking abuses. The ability to perceive and analyze information was reduced, violations in emotional sphere and behavior were determined; rarely cramps and focal symptoms were detected. Diagnosis of HIV-dementia is established after the elimination of opportunistic infections. It was proved that toxoplasmosis of the brain was determined more often with a decrease in the number of T-helper cells of less than 100 cells per 1 μl. MRI of the brain is one of the main methods of choice in confirming toxoplasmosis. This method can detect multiple foci with ring-shaped shade around. In most patients, the focal lesions are located in the cerebral hemispheres, may be in the cortex, thalamus, basal nuclei. It is sometimes difficult to conduct a differential diagnosis between cerebral toxoplasmosis (one focal lesion) and primary lymphoma of the brain. Carrying out CT with an isotope of thallium which rapidly builds up in the tumor helps in this case. Conclusions: 1) optimization of research methods in testing for HIV, reduction of the number of patients in whom the diagnosis is established at the later stage of the disease by expanding access to the survey, consultations especially for high-risk groups; 2) HIV infection is an important factor in the activation of latent tuberculosis; the risk of developing this infection is 5-10% per year; 3) along with the issues of early detection of HIV infection, adequate and timely diagnosis of CNS diseases in HIV-infected patients is relevant.

Keywords: HIV infection, opportunistic diseases, central nervous system, differential diagnosis

Full text: PDF (Rus) 253K

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