What is the algorithmic approach for evaluation and treatment of CNS complications in HIV infection?

Updated: Apr 12, 2018
  • Author: Regina Krel, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

A consultant often faces the challenge of differentiating slow progression of HIV-associated dementia, myelopathy, or neuropathy from an acute, new-onset process such as infection with cytomegalovirus or toxoplasmosis. Such intervening conditions must be diagnosed rapidly and appropriate treatment initiated expeditiously.

Failure to recognize a potentially reversible condition that is fatal if not treated would constitute deviation from the standard of care. Multiple ancillary tests need to be performed, even when the level of suspicion is relatively low.

Imaging studies often make diagnoses rather than just confirming them. The most sensitive study is often MRI with and without contrast agents. If MRI is not available or if patient motion is expected to compromise the image, head CT scan without and with intravenous contrast is the next best option.

Several algorithms have been developed for the evaluation and treatment of adult HIV-seropositive patients with neurologic symptoms and signs. [16] These algorithms proceed through several branch points, depending on the results of previous tests.


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