HIV-associated complications

HIV-associated complications

Updated: 08/10/2025

© Jun Wang, MD, PhD

 

HIV-associated neurocognitive disorder

  • Associated with neuronal injuries caused by viral components (gp120, gp41, etc) and autoimmune activities
  • Cognitive impairment
  • MRI findings include cortical and subcortical atrophy 
  • Three stages
    • Asymptomatic neurocognitive impairment (ANI): a score of ≥ 1 standard deviation below the mean in at least two cognitive domains on standardized neuropsychological testing without a symptomatic or observable functional impairment
    • Mild neurocognitive disorder (MND): a score of ≥ 1 standard deviation below the mean in at least two cognitive domains on standardized neuropsychological testing with at least mild symptomatic or functional impairment
    • HIV-associated dementia (HAD): a score of ≥ 2 standard deviations below the mean in at least two cognitive domains on standardized neuropsychological testing with concomitant impairment in activities of daily living

HIV-associated distal symmetric polyneuropathy

  • Most common peripheral nervous system manifestation
  • May be associated with advance HIV or ART
  • Probably resulted from gp120 toxicity through CXCR4 receptors in Schwann cells, causing neuronal injury or apoptosis
  • Distal axonal degradation, dorsal root ganglia neuronal loss and reduced peripheral nerve density
  • Asymptomatic or presents with bilateral abnormal sensation starting distally, and/or autonomic dysfunction
  • Clinical diagnosis based on history of HIV and clinical presentations
  • Need to rule out other peripheral neuropathies associated with diabetes, etc
  • Treatment: ART and symptom management

HIV-associated nephropathy

  • Commonly seen when CD4+ cells <200/mcl
  • Incidence declining due to ART
  • Might be associated with HIV infection of renal epithelial cells
  • Collapsing form of focal segmental glomerulosclerosis, dilated tubules and interstitial inflammation
  • Clinically nephrotic range proteinuria (>3g/24h) and rapid decline of renal function
  • Hematuria, hypertension and edema may occur
  • Definitive diagnosis based one renal biopsy in pts with <200 CD4+ cells/mcl, HIV viremia, and/or nonadherence to ART
  • Treatment: ART, renin-angiotensin system inhibitors, glucocorticoids

 

 

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Contents

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Anemia

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Bleeding disorders

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