Neurological complications of HIV infection

About one third of patients with HIV infection show neurological complicati ons with considerable morbidity and high mortality. This is an actualised r eview of the most important neurological manifestations resulting from prim ary HIV infection, from secondary opportunistic infections, or as complicat ions of antiretroviral therapy. The primary neurological manifestations, in cluding HIV-associated dementia complex, myelopathies, peripheral neuropath ies and myopathies, the more common opportunistic infections, primary centr al nervous system lymphoma and cerebrovascular diseases, are discussed in t he light of new evidence in diagnosis, therapy and prognosis. Cognitive and psychiatric symptoms, visual changes, headache, seizures, dizziness, invol untary movements, gait disturbances, cranial neuropathies and focal deficit s are the common neurological symptoms in HIV infection which are described under the aspect of differential diagnosis. It is important to bear in min d that nearly all information available to date on this subject concerns HI V patients in the period before combination therapies (including protease i nhibitors). The introduction of highly active antiretroviral therapy (HAART ) with protease inhibitors in 1995, and non-nucleoside reverse transcriptas e inhibitors, have opened up new therapeutic modalities with a new emphasis on earlier detection and treatment of neurological complications. The prog nosis of different HIV-associated neurological diseases has considerably im proved, as recently shown in the case, for example, of progressive multifoc al leucoencephalopathy.