1. HIV/AIDS Patient with a “Neuro” presentation. Diagnostic Approach
HIV Infection of the CNS
HIV/AIDS Patient with a “Neuro” presentation. Diagnostic Approach
Conrad K. Muzoora
Mbarara University
Eric Miller - Epi April 2013 1

2. How Does HIV Affect the Nervous System?
HIV Infection of the CNS
How Does HIV Affect the Nervous System?
HIV easily crosses the blood-brain barrier
Dave R, Pomerantz RJ. (2005). HIV neuropathogenesis: persistent infection, persistent questions. Science & Medicine.
Eric Miller - Epi April 2013 2

3. How Does HIV Affect the Nervous System?
HIV Infection of the CNS
How Does HIV Affect the Nervous System?
Primary HIV Disease can lead to:
AIDS Dementia Complex (brain)
Vacuolar Myelopathy (spinal cord)
Peripheral Neuropathy (nerve)
Meningitis (acute and chronic)
Eric Miller - Epi April 2013 3

4. How Does HIV Affect the Nervous System?
HIV Infection of the CNS
How Does HIV Affect the Nervous System?
General immunosuppression can lead to:
Opportunistic Infections
Fungal (Cryptococcal Meningitis)
Parasitic (Toxoplasmosis)
Viral (Progressive Multifocal Leukoencephalopathy)
HIV-Related Tumors
Eric Miller - Epi April 2013 4

5. For Today we concentrate on CNS Infections due to reduced Immunity
HIV Infection of the CNS
For Today we concentrate on CNS Infections due to reduced Immunity
Acute Chronic
Bacterial Meningitis Tuberculosis Meningitis
Viral Meningitis Cryptococcal meningitis
Eric Miller - Epi April 2013 5

6. CCM Clinical History Serum Diagnostics CSF Based Diagnosis
Indian Ink 70-80%
CRAG-latex 97%
Crag-LFA 99%
Culture 90%
PCR Biofire: Under evaluation 85%vs98% Prel

7. Crag LFA (Immy)

8. Biofire

9. TBM Very Challenging to Diagnose High Index of suspicion.
Clinical most of the time as opposed to laboratory confirmation

10. clinical case definition as described by Marais
Definite, Probable, Possible
Clinical criteria score 6
CSF criteria Score 4
Cerebral imaging criteria score 6
Evidence of tuberculosis elsewhere =4
Exclusion of alternative diagnoses

11. Current CSF Diagnostics
ZN Smear very low yeald max 15-20% after large volume csf centrifugation
Genexpert 43%
Ultra 70%
Culture 43%
Nathan C Bahr & ASTRO
Lancet Infect Dis 2017

12. Goals of Current Research
HIV Infection of the CNS
Goals of Current Research
Early and timely diagnosis of TBM in Late Stage HIV
Early and Timely diagnosis of asymptomatic crypto and effective prevention
Improve outcomes for TBM and CCM
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13. HIV Infection of the CNS
Thank You
Eric Miller - Epi April 2013 13