Neurologic Complications of HIV

Module 15, Version 4


  • Abrams DI, Jay CA, Shade SB, et al. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology. 2007;68(7):515-21.
  • Alfahad T, Nath A. Update on HIV-associated neurocognitive disorders. Curr Neurol Neurosci Rep. 2013;13:387.
  • American Academy of Neurology. Opportunistic and fungal infections of the central nervous system. Neurol Continuum. 2002;8:125.
  • American Academy of Neurology. Opportunistic infections: toxoplasmosis. The Neurologic complications of AIDS. Neurol Continuum. 2000;6:128-149.
  • American Academy of Neurology. Primary central nervous system lymphoma in AIDS. The Neurologic complications of AIDS. Neurol Continuum. 2000;6:177-185.
  • Anders HJ, Goebel FD. Neurological manifestations of cytomegalovirus infection in the acquired immunodeficiency syndrome. Int J STD AIDS. 1999;10:151-161.
  • Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology. 2007;69:1789-1799.
  • Banerjee S, McCutchan JA, Ances BM, et al. Hypertriglyceridemia in combination antiretroviral-treated HIV-positive individuals: potential impact on HIV sensory polyneuropathy. AIDS. 2011;25:F1-F6.
  • Banks LT, Geraci A, Liu M, et al. A natural history of HIV myelopathy in the HAART era. Neurology. 2002;A441.
  • Birbeck G, French J, Perucca E, et al. Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy. Neurology. 2012;78;139-145.
  • Boisse L, Gill M J, Power C. HIV infection of the central nervous system: clinical features and neuropathogenesis. Neurol Clin. 2008;26:799-819.
  • Bonnet F, Amieva H, Marquant F, et al. Cognitive disorders in HIV-infected patients: are they HIV-related? AIDS. 2013;27:391-400.
  • Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014;370:2487-2498.
  • Carvalhal A, Gill MJ, Letendre SL, et al. Central nervous system penetration effectiveness of antiretroviral drugs and neuropsychological impairment in the Ontario HIV Treatment Network Cohort Study. J Neurovirol. 2016;22:349-357.
  • Chong J, Di Rocco A, Tagliati M, Danisi F, Simpson DM, Atlas SW. MR findings in AIDS-associated myelopathy. Amer J Neuroradiol. 1999;20:1412-1416.
  • Cinque P, Cleator GM, Weber T, et al. Diagnosis and clinical management of neurological disorders caused by cytomegalovirus in AIDS patients. J Neurovirol. 1998;4:120-132.
  • Clotet B, Feinberg J, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naïve adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase IIIb study. Lancet. 2014;383:2222-2231.
  • Cornblath DR, McArthur JC. Predominantly sensory neuropathy in patients with AIDS and AIDS-related complex. Neurology. 1988;38:794-796.
  • Daar ES, Tierney C, Fischl M, et al. Atazanavir plus ritonavir or efavirenz as part of a 3-drug regimen for initial treatment of HIV-1. Ann Intern Med. 2011;154:445-456.
  • Dal Pan GJ, Glass JD, McArthur JC. Clinicopathologic correlations of HIV-1-associated vacuolar myelopathy: an autopsy-based case-control study. Neurology. 1994;4:2159-2164.
  • >Dalakas MC, Cupler EJ. Neuropathies in HIV infection. Baillieres Clin Neurol. 1996;5:199-218. /li>
  • De Boer MG, van den Berk GE, van Holten N, et al. Intolerance of dolutegravir-containing combination antiretroviral therapy regimens in real-life clinical practice. AIDS. 2016;30(18):2831-2834.
  • DeVivo DC, Percy AK, Chiriboga CA, et al. Neuromuscular disorders in HIV-1 infection. Continuum. 2000;6:73-76.
  • Di Rocco A, Simpson DM. AIDS-associated vacuolar myelopathy. AIDS Patient Care STDS. 1998;12:457-461.
  • Di Rocco A. Diseases of the spinal cord in human immunodeficiency virus infection. Semin Neurol. 1999;19:151-155.
  • Dorfman D, George MC, Schnur J, et al. Hypnosis for treatment of HIV neuropathic pain: a preliminary report. Pain Med. 2013;14:1048-1056.
  • Ellis RJ, Letendre SL, Vaida F, et al. Randomized trial of central nervous system targeted antiretrovirals for HIV-associated neurocognitive disorder. Clin Infect Dis. 2014;58:1015-1022.
  • Ellis RJ, Rosario D, Clifford DB, et al. Continued high prevalence and adverse clinical impact of human immunodeficiency virus-associated sensory neuropathy in the era of combination antiretroviral therapy: the CHARTER Study. Arch Neurol. 2010;67:552-558.
  • ENCORE1 Study Group, Puls R, Amin J, et al. Efficacy of 400 mg efavirenz versus standard 600 mg dose in HIV-infected, antiretroviral-naïve adults (ENCORE1): a randomised, double-blind, placebo-controlled, non-inferiority trial. Lancet. 2014;383:1474-1482.
  • Evaluation and management of intracranial mass lesions in AIDS: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1998;50:21-26.
  • Evans SR, Ellis RJ, Chen H, et al. Peripheral neuropathy in HIV: prevalence and risk factors. AIDS. 2011;25:919-928.
  • Ferretti F, De Zan V, Gerevini S, et al. Relapse of symptomatic cerebrospinal fluid HIV escape. Curr HIV/AIDS Rep. 2020 Sep 1. doi: 10.1007/s11904-020-00526-x. Online ahead of print.
  • Fettiplace A, Stainsby C, Winston A, et al. Psychiatric symptoms in patients receiving dolutegravir. J Acquir Immune Defic Syndr. 2017;74(4):423-431.
  • Gambarin KH, Hamill RJ. Management of increased intracranial pressure in cryptococcal meningitis. Curr Infect Dis Reports. 2002;4:332-338.
  • Gatell JM, Morales-Ramirez JO, Hagins DP, et al. Doravirine dose selection and 96-week safety and efficacy versus efavirenz in antiretroviral therapy-naive adults with HIV-1 infection in a Phase IIb trial. Antivir Ther. 2019;24(6):425-435.
  • Hamada Y, Watanabe K, Aoki T, et al. Primary HIV infection with acute transverse myelitis. Intern Med. 2011;50:1615-1617.
  • Hasbun R, Eraso J, Ramireddy S, et al. Screening for neurocognitive impairment in HIV individuals: the utility of the Montreal cognitive assessment test. J AIDS Clinic Res. 2012;3:10.
  • Hasbun R. The acute aseptic meningitis syndrome. Curr Infect Dis Rep. 2000;2:345-351.
  • Heemskerk AD, Bang ND, Thwaites GE. Therapy for tuberculous meningitis. N Engl J Med. 2016;374:2188-2189.
  • Hoffman C, Welz T, Sabranski M, et al. Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients. HIV Med. 2017;18(1):56-63.
  • Hoffmann C, Llibre JM. Neuropsychiatric adverse events with dolutegravir and other integrase strand transfer inhibitors. AIDS Rev. 2019;21(1):4-10.
  • Hsu R, Fusco J, Heneger C, et al. Psychiatric outcomes observed in patients living with HIV using six common antiretrovirals in the Observational Pharmaco-Epidemiology Research and Analysis database. Ther Adv Drug Saf. 2018;9(12):675-686.
  • Huis in’t Veld D, Sun HY, Hung CC, Colebunders R. The immune reconstitution inflammatory syndrome related to HIV co-infections: a review. Eur J Clin Microbiol Infect Dis. 2012;31:1413-1419.
  • Jacks A, Wainwright D, Salazar L, et al. Neurocognitive deficits increase lack of retention in care among older with newly diagnosed HIV infection. AIDS. 2015;29(13):1711–1714.
  • Keswani SC, Polley M, Pardo CA, et al. Schwann cell chemokine receptors mediate HIV-1 gp120 toxicity to sensory neurons. Arch Neurol. 2003;54:287-296.
  • Letendre S, Mills A, Hagins D, et al. Distribution in Cerebrospinal Fluid (CSF) of Cabotegravir (CAB) and Rilpivirine (RPV) After Intramuscular Administration of Long-Acting (LA) Injectable Suspensions in HIV-1-Infected Patients. J Int AIDS Soc. 2018. 21(S8):e25187.
  • Letendre S, Mills AM, Tashima KT, et al. ING116070: a study of the pharmacokinetics and antiviral activity of dolutegravir in the cerebrospinal fluid in HIV-1-infected, antiretroviral therapy-naïve subjects. Clin Infect Dis. 2014 Oct:59(7):1032-7.
  • Letendre S. Central nervous system complications in HIV Disease: HIV-associated neurocognitive disorder. Top Antivir Med. 2011;19:137-142.
  • Livelli A, Vaida F, Ellis RJ, et al. Correlates of HIV RNA concentrations in cerebrospinal fluid during antiretroviral therapy: a longitudinal cohort study. Lancet HIV. 2019;6(7):e456-e462.
  • Llibre JM, Montoliu A, Miro JM, et al. Discontinuation of dolutegravir, elvitegravir/cobicistat and raltegravir because of toxicity in a prospective cohort. HIV Med. 2019;20(3):237-247.
  • McCutchan JA. Cytomegalovirus infections of the nervous system in patients with AIDS. Clin Infect Dis. 1995;20:747-754.
  • Métral M, Darling K, Locatelli I, et al. The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile. HIV Med. 2020;21(1):30-42.
  • Mukerji SS, Misra V, Lorenz D, et al. Impact of antiretroviral regimens on cerebrospinal fluid viral escape in a prospective multicohort study of antiretroviral therapy-experience Human immunodeficiency virus-1-infected adults in the United States. Clin Infect Dis. 2018;67(8):1182-1190.
  • Nichols, M, Gates T, Soares JR, et al. Atrophic brain signatures of mild forms of neurocognitive impairment in virally suppressed HIV infection. AIDS. 2019;33(1):55-66.
  • Orrell C, Hagins DP, Belonosova E, et al. Fixed-dose combination dolutegravir, abacavir, and lamivudine versus ritonavir-boosted atazanavir plus tenofovir disoproxil fumarate and emtricitabine in previously untreated women with HIV-1 infection (ARIA): week 48 results from a randomised, open-label, non-inferiority, phase 3b study. Lancet HIV. 2017;4(12):e536-e546.
  • Pardo CA, McArthur JC, Griffin JW. HIV neuropathy: insights in the pathology of HIV peripheral nerve disease. J Peripher Nerv Syst. 2001;6:21-27.
  • Park H, Song Y. Multiple tuberculoma involving the brain and spinal cord in a patient with miliary pulmonary tuberculosis. J Korean Neurosurg Soc. 2008;44(1):36–39.
  • Patel AK, Patel KK, Gohel S, Kumar A, Letendre S. Incidence of symptomatic CSF viral escape in HIV infected patients receiving atazanavir/ritonavir-containing ART: a tertiary care cohort in western India. J Neurovirol. 2018:24(4):498-505.
  • Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the treatment of cryptococcal disease: 2010 Update from the Infectious Diseases Society of America. Clin Infect Dis. 2012;50:291-322.
  • Petito CK, Vecchio D, Chen YT. HIV antigen and DNA in AIDS spinal cords correlate with macrophage infiltration but not with vacuolar myelopathy. J Neuropathol Exp Neurol. 1994;53:86-94.
  • Phillips TJ, Cherry CL, Cox S, et al. Pharmacological treatment of painful HIV-associated sensory neuropathy: a systematic review and meta-analysis of randomised controlled trials. PLOS One. 2010;5:e14433.
  • Portegies P, Solod L, Cinque P, et al. EFNS task force guidelines for the diagnosis and management of neurological complications of HIV infection. Eur J Neurol. 2004;11:297-304.
  • Raffi F, Rachlis A, Stellbrink HJ, et al. Once-daily dolutegravir versus raltegravir in antiretroviral-naïve adults with HIV-1 infection: 48 week results from the randomised, double-blind, non-inferiority SPRING-2 study. Lancet. 2013;381:735-743.
  • Robinson-Papp J, Gonzalez-Duarte A, Simpson DM, et al. The roles of ethnicity and antiretrovirals in HIV-associated polyneuropathy: a pilot study. J Acquir Immun Defic Syndr. 2009;51:569-573.
  • Rockstroh JK, DeJesus E, Lennox JL, et al. durable efficacy and safety of raltegravir versus efavirenz when combined with tenofovir/emtricitabine in treatment-naïve HIV-1–infected patients: final 5-year results from STARTMRK. J Acquir Immune Defic Syndr. 2013;63:77-85
  • Rosca EC, Albarqouni L, Simu M. Montreal cognitive assessment (MoCA) for HIV-associated neurocognitive disorders. Neuropsychol Rev. 2019;29(3):313-327.
  • Sandoval R, Runft B, Roddey T. Pilot study: does lower extremity night splinting assist in the management of painful peripheral neuropathy in the HIV/AIDS population? J Int Assoc Phys AIDS Care (Chic). 2010;9:368-381.
  • Santos AM, Locatelli I, Metral M, et al. Cross-sectional and cumulative longitudinal central nervous system effectiveness scores are not associated with neurocognitive impairment in a well treated aging HIV-positive population in Switzerland. Open Forum Infect Dis. 2019:6(7);ofz277.
  • Sidtis JJ, Gatsonis C, Price RW, et al. Zidovudine treatment of the AIDS dementia complex: results of a placebo-controlled trial. Ann Neurol. 1993;33:343-349.
  • Silva CA, Penalva de Oliveira AC, et al. Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature. Rev Inst Med Trop. 2010;52:305-310.
  • Simpson DM, Brown S, Tobias J. NGX-4010 C107 Study Group. Controlled trial of high-concentration capsaicin patch for treatment of painful HIV neuropathy. Neurology. 2008;70:2305-2313.
  • Simpson DM, Kitch D, Evans SR, et al. HIV neuropathy natural history cohort study: assessment measures and risk factors. Neurology. 2006;66:1679-1687.
  • Smyth K, Affandi JS, McArthur JC, et al. Prevalence of and risk factors for HIV-associated neuropathy in Melbourne, Australia 1993–2006. HIV Med. 2007;8:367–373.
  • Spudich S, Robertson KR, Bosch RJ, et al. Persistent HIV-infected cells in cerebrospinal fluid are associated with poorer neurocognitive performance. J Clin Invest. 2019;129(8):3339-3346.
  • Tagliati M, Grinnell J, Godbold J, Simpson DM. Peripheral nerve function in HIV infection: clinical, electrophysiologic, and laboratory findings. Arch Neurol. 1999;56:84-89.
  • The Mind Exchange Working Group. Assessment, diagnosis, and treatment of HIV-associated neurocognitive disorder: a consensus report of the Mind Exchange Program. Clin Infect Dis. 2013;56:1004-1017.
  • Tiraboschi J, Imaz A, Khoo S, et al. Total and unbound bictegravir concentrations and viral suppression in cerebrospinal fluid of Human immunodeficiency virus-infected patients (Spanish HIV/AIDS Research Network, PreEC/RIS 56). J Infect Dis. 2020;221(9):1425-1428.
  • Tyor WR, Glass JD, Baumrind N, et al. Cytokine expression of macrophages in HIV-1-associated vacuolar myelopathy. Neurology. 1993;43:1002-1009.
  • Valcour V, Paul R, Chiao S, Wendelken LA, Miller B. Screening for cognitive impairment in human immunodeficiency virus. Clin Infect Dis. 2011;53:836-842.
  • Valcour VG. Evaluating cognitive impairment in the clinical setting: practical screening and assessment tools. Top Antivir Med. 2011;19:175-180.
  • Veltman JA, Bristow CC, Klausner JD. Meningitis in HIV-positive patients in sub-Saharan Africa: a review. J Int AIDS Soc. 2014;17:19184.
  • Walmsley SL, Antela A, Clumeck N, et al. Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369:1807-1818.
  • Wang SX, Ho EL, Grill M, et al. Peripheral neuropathy in primary HIV infection associates with systemic and CNS immune activation. J Acquir Immun Defic Syndr. 2014;66:303-310.
  • Wulff EA, Simpson DM. Neuromuscular complications of HIV-1 Infection. Curr Infect Dis Rep. 1999;1:192-197.
  • Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. May 26, 2020. Available at Accessed September 7, 2020.
  • Andrea C, Borghetti A, Milesi M, et al. Clinical features and outcomes of patients stopping DTG for neuropsychiatric symptoms. Program and abstracts of the 2020 Conference on Retrovirus and Opportunistic Infections. Virtual. March 8-11, 2020. Abstract 442.
  • Ellis RJ, Diaz M, Sacktor N, et al. Predictors of sensory neuropathy and neuropathic symptom worsening after 12 years in aging people with HIV. Program and abstracts from the 2020 International AIDS Conference. July 6-10, 2020. Abstract PEA0088.
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