ABSTRACT
Infection with the human immunodeficiency virus can affect the entire nervous system by causing an aseptic meningitis, dementing illness, myelopathy, or peripheral neuropathy. The virus has a predilection for the basal ganglia and thus causes a subcortical dementia. Milder forms of cognitive impairment occur despite adequate antiviral therapy and occasionally patients may develop an immune reconstitution syndrome. The virus infects macrophages, microglial cells, and astrocytes within the nervous system where it establishes a reservoir. Viral proteins released from these cells lead to a cascade of events resulting in neuroglial and blood–brain barrier dysfunction. Treatment involves using antiretroviral drugs with good brain penetration and symptomatic therapy.
