How are these disorders treated? What research is being done? Where can I get more information? The resulting shortage of these cells leaves people infected with HIV vulnerable to other infections and diseases, and additional complications. Many of the most severe neurological conditions can be prevented with antiretroviral therapy. However, even individuals who receive this treatment can develop less severe neurological and cognitive difficulties. HIV does not directly invade nerve cells neurons but puts their function at risk by infecting cells called glia that support and protect neurons.
HIV also triggers inflammation that may damage the brain and spinal cord central nervous system and cause symptoms such as:. Damage to the peripheral nerves can cause progressive weakness and loss of sensation in the arms and legs. Research has shown that HIV infection can cause shrinking of brain structures involved in learning and information processing. Other nervous system complications that can occur as a result of HIV infection or the drugs used to treat it include:.
These symptoms may be mild in the early stages of AIDS but can become increasingly severe. This is because many drugs used to combat HIV cannot cross the protective layer called the blood-brain barrier and enter the brain, and even those that can may not completely control the virus in the brain. Antiretroviral drugs can also become toxic after long-term use and cause neurological side effects.
AIDS-related disorders of the nervous system may be caused directly by the HIV virus, by certain cancers and opportunistic infections illnesses caused by bacteria, fungi, and other viruses that would not otherwise affect people with healthy immune systems , or by toxic effects of the drugs used to treat symptoms.
Other neuro-AIDS disorders of unknown origin may be influenced by but are not caused directly by the virus. Symptoms include encephalitis inflammation of the brain , behavioral changes, and a gradual decline in cognitive function, including trouble with concentration, memory, and attention. Persons with ADC also show progressive slowing of motor function and loss of dexterity and coordination.
When left untreated, ADC can be fatal. It is rare when anti-retroviral therapy is used. Neuropsychologic testing can reveal subtle deficits even in the absence of symptoms. Central nervous system CNS lymphomas are cancerous tumors that either begin in the brain or result from a cancer that has spread from another site in the body. CNS lymphomas are almost always associated with the Epstein-Barr virus a common human virus in the herpes family.
Symptoms include headache, seizures, vision problems, dizziness, speech disturbance, paralysis, and mental deterioration. Individuals may develop one or more CNS lymphomas. Prognosis is poor due to advanced and increasing immunodeficiency, but is better with successful HIV therapy. Cryptococcal meningitis is seen in about 10 percent of untreated individuals with AIDS and in other persons whose immune systems have been severely suppressed by disease or drugs.
It is caused by the fungus Cryptococcus neoformans , which is commonly found in dirt and bird droppings. The fungus first invades the lungs and spreads to the covering of the brain and spinal cord, causing inflammation. Symptoms include fatigue, fever, headache, nausea, memory loss, confusion, drowsiness, and vomiting. If left untreated, patients with cryptococcal meningitis may lapse into a coma and die. Cytomegalovirus CMV infections can occur concurrently with other infections.
Symptoms of CMV encephalitis include weakness in the arms and legs, problems with hearing and balance, altered mental states, dementia, peripheral neuropathy, coma, and retinal disease that may lead to blindness.
CMV infection of the spinal cord and nerves can result in weakness in the lower limbs and some paralysis, severe lower back pain, and loss of bladder function. It can also cause pneumonia and gastrointestinal disease. Herpes virus infections are often seen in people with AIDS. The herpes zoster virus , which causes chickenpox and shingles, can infect the brain and produce encephalitis and myelitis inflammation of the spinal cord.
It commonly produces shingles, which is an eruption of blisters and intense pain along an area of skin supplied by an infected nerve. In people exposed to herpes zoster, the virus can lay dormant in the nerve tissue for years until it is reactivated as shingles. This reactivation is common in persons with AIDS because of their weakened immune systems.
Signs of shingles include painful blisters like those seen in chickenpox , itching, tingling, and pain in the nerves. Skin lesions can differ in appearance and symptoms. The severity of your condition can also vary, and it may even coincide with the effectiveness of your current HIV treatment. Your doctor can help you treat them and make adjustments to your overall HIV treatment plan if needed.
Learn more about HIV-associated rash. It forms dark skin lesions along blood vessels and lymph nodes, and it can be red, brown, or purple in color.
This condition often occurs in the later stages of HIV when the T4 cell count is low, and the immune system is weak. Outbreaks are treated with prescription medications to clear up lesions and prevent their spread. In severe cases, the blisters may even form on the eyes. Herpes lesions are caused by the same virus related to chickenpox. Having herpes increases your risk for developing shingles.
Oral hairy leukoplakia is a mouth infection caused by a mouth virus. It appears as white lesions across the tongue, and many of the spots have a hairy appearance. There is no direct treatment for oral hairy leukoplakia lesions. Clearing up the problem instead relies on your overall HIV treatment plan. Molluscum contagiosum is a skin condition that causes bumps ranging from the color of your flesh to dark pink. Psoriasis is a skin condition caused by problems in the immune system, where skin cells develop faster than they should.
The result is a buildup of dead skin cells that often turn silver in color. These scales can occur on any area of the body and may turn red and inflamed without treatment. Retinoid creams and phototherapy may be more effective alternatives. This skin condition is characterized by yellow, oily, and scaly plaques. When irritated, scratched, and inflamed, the scales can open and bleed. The condition is treated with either over-the-counter or prescription strength hydrocortisone, but your doctor may also prescribe an antibiotic for open wounds to prevent infection.
Diagnosis is through examination of lesions or the use of a biopsy. The most commonly used psoriasis treatments in HIV-negative individuals can suppress the immune system, which is potentially problematic for individuals with HIV. Some research suggests that acitretin or apremilast may be good options for treating psoriasis in individuals with HIV. For people with an undetectable viral load, Tumor necrosis factor TNF agonists may also be a treatment option.
If psoriasis symptoms are severe in HIV-positive individuals, immunosuppressive drugs may sometimes be needed. Antiretroviral treatment for HIV may also reduce the symptoms of psoriasis as the immune system becomes stronger. Scabies is a skin infestation caused by a mite. It causes a red or purple rash that is extremely itchy. This rash may contain lines, or burrows, connecting infected areas.
It may also have pimples, bumps, or pus. Scabies is very easy to transmit by skin-to-skin contact. As the rash is similar to many other rashes, it must be diagnosed by a doctor. Diagnosis is usually through examining a scraping of skin under a microscope. People with HIV may develop more severe manifestations of scabies, sometimes called crusted scabies or Norwegian scabies.
These types of scabies may be more difficult to treat. They appear as crusted, grey, raised plaques on the skin. These sores may cause skin breakdown and become infected with bacteria.
In addition to infections caused by skin breakdown, if a scabies infection is scratched there is a risk of secondary infection with bacteria. This can potentially cause severe side effects including skin abscesses, kidney disease, and even rheumatic heart disease. Both oral and topical treatments are available for scabies. Topical treatment is with permethrin, and oral treatment is with ivermectin. Ivermectin appears to be somewhat preferable in HIV-positive individuals, although the World Health Organization recommends permethrin first for mild cases.
Additional antibiotics may be needed if a secondary skin infection develops. Thrush is caused by infection with a type of yeast known as Candida. Thrush is also known as candidiasis. Although most people have Candida on their skin and in the mouth, thrush occurs when this yeast overgrows. The most common symptom of thrush is thick, whitish patches in the mouth and throat. Unlike oral hairy leukoplakia, these patches may be scraped off. Thrush can also occur in other areas of the body such as in the vagina and the rectum.
Symptoms in these locations may include changes in discharge. Severe thrush, and thrush outside the mouth, are more common in individuals with HIV.
In addition, because thrush that occurs outside the mouth is more common in individuals with a CD4 count under , it is an AIDS-defining condition.
Systemic thrush and disseminated thrush occur when the yeast infection spreads throughout one or more organs. These conditions can occasionally become very serious or even fatal in individuals with advanced HIV disease. Thrush is diagnosed by the examination of scrapings for Candida species.
Treatment for thrush uses oral or topical antifungal medications. Relapses are common, and treatment may need to be prolonged. Unfortunately, thrush may develop resistance to common forms of treatment in individuals who are immunocompromised and on long-term therapy, such as individuals with HIV. In both adults and children, oral fluconazole is the preferred treatment for oral thrush. Topical treatment with nystatin or clotrimazole is also an option.
Sores, rashes, and other skin conditions are relatively common in individuals who are immunocompromised from HIV infection. Conditions that produce lesions include herpes, Kaposi's sarcoma, oral hairy leukoplakia, molluscum contagiosum, seborrheic dermatitis, psoriasis, scabies, and thrush. Many HIV-related skin lesions are treatable. The degree to which these skin conditions are serious often reflects the severity of the underlying HIV infection rather than the skin disease causing the lesion.
Where treated, the prognosis of these infections is generally good. Most people with HIV will experience skin lesions at some point in their infection. The best way to prevent these conditions is through prompt and appropriate HIV treatment. Daily use of antiretroviral therapy can reduce the risk of severe HIV-related skin lesions. Get information on prevention, symptoms, and treatment to better ensure a long and healthy life.
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Geneva: World Health Organization; Johns Hopkins Medicine. Oral hairy cell leukoplakia.
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