Human immunodeficiency virus-associated meningitis: Clinical course and correlations

doi:10.1016/0002-9343(87)90635-8

The American Journal of Medicine

Volume 83, Issue 5, November 1987, Pages 813-816

https://doi.org/10.1016/0002-9343(87)90635-8 Get rights and content

Abstract

Fourteen patients infected with human immunodeficiency virus (HIV) had a lymphocytic pleocytosis unexplained by secondary pathogens or neoplasms. Three men had prior diagnoses of Kaposi's sarcoma; none had acquired immune deficiency syndrome-defining opportunistic infections. Two patterns of illness were observed. Seven men had an acute, self-limited illness that was often accompanied by meningeal findings. The other seven had chronic headaches without signs of meningeal irritation and had less marked abnormalities of cerebrospinal fluid (CSF) cell count and protein. Encephalopathy was a finding in only one of 14 patients. In four of five CSF specimens studied, HIV was recovered. HIV has been associated with acute meningitis at the time of seroconversion and can apparently also cause sporadic episodes of acute or chronic meningitis in patients with prior infection and relatively preserved immune function. Both the clinical presentation with pre-dominant headache rather than encephalopathy and the presence of CSF inflammation differentiate this syndrome from other HIV-related neurologic complications.

References (9)

WD Snider et al.
Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients
Ann Neurol
(1983)
RM Levy et al.
Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature
J Neurosurg
(1985)
BA Navia et al.
The AIDS dementia complex. 1. Clinical findings
Ann Neurol
(1986)
DD Ho et al.
Primary human T-lymphotropic virus type III infection
Ann Intern Med
(1985)

There are more references available in the full text version of this article.

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^☆: This work was supported by grants from the University of California Systemwide Taskforce on AIDS and was presented in part at the Third International Conference on AIDS in Washington, D.C., June 1987.

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Clinical studiesHuman immunodeficiency virus-associated meningitis: Clinical course and correlations☆

Abstract

Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients

Ann Neurol

Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature

J Neurosurg

The AIDS dementia complex. 1. Clinical findings

Ann Neurol

Primary human T-lymphotropic virus type III infection

Ann Intern Med

Clinical studies
Human immunodeficiency virus-associated meningitis: Clinical course and correlations☆