Subject(s)
Flunarizine/therapeutic use , Histamine H1 Antagonists/therapeutic use , Migraine Disorders/prevention & control , Vasodilator Agents/therapeutic use , Adult , Age Factors , Child , Child, Preschool , Contraindications , Controlled Clinical Trials as Topic , Double-Blind Method , Flunarizine/administration & dosage , Flunarizine/adverse effects , Histamine H1 Antagonists/administration & dosage , Histamine H1 Antagonists/adverse effects , Humans , Placebos , Time Factors , Vasodilator Agents/administration & dosage , Vasodilator Agents/adverse effectsABSTRACT
In up to 50% of all human immunodeficiency virus (HIV) patients, the nervous system is clinically involved. Primary or secondary manifestations of the nervous system have been found in even 90% by neuropathological investigations. We present a retrospective analysis of cerebrospinal fluid (CSF) and serum data of 238 HIV patients. Data of cross-sectional analysis in 208 patients and longitudinal analysis in 30 patients are given. In addition, the viral load in CSF and serum was determined in 29 patients. The HIV patients without opportunistic infections showed increased levels of immunoglobulins and more oligoclonal bands. In later stages of the infection, beta-2 microglobulin as a marker of HIV-associated encephalopathy was increased. In the longitudinal study with an observation period of 1 year, an increase could be observed in total CSF proteins of patients who did not receive antiretroviral treatment. In patients with new opportunistic infections of the central nervous system, similar changes in CSF parameters were noted as in comparison to patients not infected by HIV but with the same opportunistic infections. Analysis of CSF is mandatory for the diagnosis and control of opportunistic infections.
Subject(s)
HIV Infections/cerebrospinal fluid , HIV Infections/epidemiology , AIDS-Related Opportunistic Infections/blood , AIDS-Related Opportunistic Infections/cerebrospinal fluid , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Adult , Antiviral Agents/therapeutic use , Comorbidity , Cross-Sectional Studies , Female , Germany/epidemiology , HIV Infections/blood , HIV Infections/drug therapy , Humans , Longitudinal Studies , Male , Retrospective Studies , Risk FactorsABSTRACT
Highly active antiretroviral therapy (HAART) has resulted in a reduction of morbidity and mortality in HIV-associated cerebral opportunistic infection. Before HAART, up to 50% of all HIV-infected patients in Europe developed cerebral toxoplasmosis, an encephalitis caused by reactivation of Toxoplasma gondii infection. Although potent therapeutical options exist, the prognosis is still poor. We describe the course of 36 AIDS patients with cerebral toxoplasmosis and present a review of clinical signs, diagnosis, therapy, and survival times. The main criteria for differential diagnosis from other secondary neuromanifestations such as primary CNS lymphoma, progressive multifocal leukencephalopathy, abscesses, and ischemic infarctions are described. Indications and problems of stereotactic biopsy are discussed.