Hiv

Cerebral infection is a frequent accompaniment of HIV infection, with 39-70% of those with AIDS suffering from neurological complications.41,42 HIV enters the central nervous system soon after primary infection and causes symptoms both as a primary effect of the virus and also secondary to the systemic immune suppression that accompanies AIDS and renders the sufferer liable to opportunistic infections. The manifestations of HIV infection of the brain coexist with opportunistic infection and may result in a complex and confused syndrome constellation. Many of the features are chronic in evolution but some are acute. In practice, any change in neurological status in a patient with AIDS usually creates a neurological emergency because of the possibility of opportunistic infection. There are excellent accounts of the epidemiology, immunology, and classification of the natural progression of HIV infection available and these matters are not discussed further here.43-46

HIV is spread by inoculation of virus by sexual intercourse, by contaminated blood or blood products, or vertically in utero, during birth, or by breast milk. Infection with HIV occurs when the viral glycoprotein, gp 120, binds to the cellular membrane CD4 molecule of T helper lymphocytes (and other cells) and the virus enters the cell cytoplasm. HIV is an RNA virus that encodes for reverse transcriptase, enabling a DNA copy of viral RNA to be produced in an infected cell. This DNA provirus is incorporated into the host genome. Because HIV can infect the neuraxis early and persist in the CNS indefinitely, CSF studies cannot prove that HIV causes a particular neurological syndrome. Some 40% of all HIV patients not receiving antiretroviral drugs have CSF abnormalities, although a large proportion is asymptomatic. There is a lymphocytic pleocytosis, raised protein, and a normal glucose content, and as many as 20% may grow HIV in culture.47,48 Antibodies, mainly IgG but also IgA and IgM, appear in CSF and p24 antigen is often present in higher concentration than in serum. Unfortunately these levels do not correlate well with clinical status. Viral load can be detected and quantified using PCR.

Pregnancy And Childbirth

Pregnancy And Childbirth

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