Neurological Problems Common in Early HIV Infection

Antiretroviral therapy may alleviate some cognitive problems among HIV-positive patients.

A large portion of newly-infected HIV patients suffer from neurological issues, but a majority can be fixed through antiretroviral therapy, a recent study revealed.

For the study, published in Neurology, researchers analyzed 139 patients in the RV254 Thai cohort who were recently infected with HIV.

“In the early days of the epidemic in San Francisco, approximately 10% of patients with recent HIV infection presented with dramatic neurological disease,” said senior study author Serena Spudich, MD. “But that was likely due to patients coming in early because of the severity of symptoms they were experiencing. The Thai cohort has given us an opportunity to look at a broad range of newly infected patients, analyze their neurological functioning systematically and follow them over time. We are gaining deeper insights into the degree to which early HIV affects the nervous system.”

From the initial infection of HIV to entry into the study, participants had a median of 19 days and a range from 3 to 56 days.

Although it was too early for patients to test positive for HIV, 53% had neurological findings, and almost 20% had neuropathy. There was only 1 severe case reported in the study of a patient who was diagnosed with Guillain-Barré Syndrome, but many other participants had more than 1 symptom.

Upon diagnosis, all study participants were started on antiretroviral therapy. The results of the study found that 90% of neurological issues listed at diagnosis were resolved after 1 month of treatment.

However, 9% of patients experienced neurological symptoms that remained unresolved 6 months after the initiation of therapy. Furthermore, researchers found there was an association between high levels of HIV found in the blood and neurological symptoms.

“This is one of the first comprehensive studies scrutinizing the involvement of the nervous system in early infection,” said study co-author Victor Valcour, MD, PhD. “Since we have been able to maintain the cohort for 5 years now, we will be able to study whether there are any persistent abnormalities that need to be addressed. Additionally, the ubiquity of symptoms in early infection found in this study reinforces the need for the brain to be considered as a compartment containing latent HIV as we design cure studies.”