Search

Central nervous system complications are common in HIV-1 infected patients and occur either as a result of concomitant immunosuppression (opportunistic infections, lymphoma and tumors), as a primary manifestation of HIV infection, or as an adverse effect of therapy (immune restoration and toxicity). These complications contribute largely to patient morbidity and mortality. In the era of highly active antiretroviral therapy (HAART) these disease states have changed in presentation, outcome and incidence. We review in detail the epidemiology, pathogenesis, clinical features, diagnosis, and management of these disorders.

Given the high rate of infection by HIV in the APAD in our country, the description of localized infectious problems in the CNS secondary to drug-addiction should always take into account opportunistic infections or tumours occurring there. The initial clinical evaluation should highlight or rule out the presence of clinical indications (specially polyadenia and oral candidiasis) which suggest a clinical condition of immunodepression. Septic embolization due to bacteremia and fungemia is common among drug-addicts, sometimes causing, although not very often in comparison with other sites, various infectious complications in the CNS (meningitis, cerebral abscess, subdural empyema or epidural abscess), "Staphylococcus aureus" being the micro-organism most frequently involved. From 1977 to 1986 the work-group for the study of infections among drug-addicts has listed 6,481 infections. Disseminated candidiasis (582 cases) and infectious endocarditis (506 cases) were the most frequent types of primary infection. Only 33 cases of infection of the CNS were observed, meningitis being the most frequent (57%). The usual empirical antibiotic treatment for meningitis is cefotaxime or cefotriaxona plus cloxacillin, and for cerebral abscess we substitute metronidazole for isoxazolic penicillin. Given the sexual habits frequently associated with APAD, neurosyphilis is suspect, since immunodepression secondary to infection by HIV causes changes in its natural behaviour. Tetanus is the most serious and uncommon infectious complication connected with drug-addiction. In our society, up to 1986 only 5 cases had been described. As for paludism, the cases detected in this country have belonged to two small outbreaks: one with four cases in Madrid with "Plasmodium vivax" and the other with three cases in Tortosa (Tarragona) with "P. falciparum".