[Neuro-AIDS in the cART era]

Abstract

After the introduction of antiretroviral combination therapy for the treatment of HIV infection in 1996 (highly active antiretroviral therapy = HAART, nowadays called combination antiretroviral therapy = cART), a steady decline in infection associated complications had been expected, especially with respect to central and peripheral nervous system manifestations. Until the beginning of the new millenium this hope came in fact true, but since then there has been a slow, but constant rise in the prevalence, and later on also in the incidence of directly virus-associated neurological complications in HIV infected patients. HIV-associated diseases that neurologists might see in their routine work include HIV-associated dementia (HAD) and its precursor stages, HIV-associated myelopathy, HIV-associated polyneuropathies and myopathies as well as the opportunistic brain infections and immune reconstitution phenomena (IRIS). This article describes practical diagnostic procedures according to the guidelines of the German Neurological Society and the respective therapeutic options.