New Mexico
AIDS
InfoNet Fact
Sheet Number 504
Nervous System Problems
- WHAT ARE NERVOUS SYSTEM PROBLEMS?
- HOW ARE NEUROLOGIC PROBLEMS DIAGNOSED?
- HOW ARE NERVE PROBLEMS TREATED?
- THE BOTTOM LINE
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PrintSYSTEM PROBLEMS?
The nervous system has two parts. The brain and spinal cord are
the central nervous system (CNS). The nerves and muscles are the
peripheral nervous system. Peripheral means around the outside.
People with HIV disease can have several nerve problems. A
common problem is peripheral neuropathy.
This causes nerve and muscle pain, especially in the feet, legs,
and hands. See Fact Sheet 555
for more information. CNS problems include depression and problems
with sleeping, balance, walking, thinking and memory.
At first, these were all called “AIDS Dementia Complex”.
However, there is a wide range of AIDS-related nerve troubles.
AIDS Dementia means ongoing major problems with thinking, memory,
and usually also with controlling the legs and arms.
Before combination antiviral therapy was available, about 20%
of people with AIDS developed dementia. There are many fewer cases
now. The exact rate is not known.
HOW ARE NEUROLOGIC PROBLEMS DIAGNOSED?
It can be difficult to know what’s causing neurologic problems.
They can be caused by vitamin deficiencies, opportunistic
infections (see Fact Sheet 500), or by antiviral medications.
Others are caused when HIV infects the brain or spinal cord.
Most mental problems don’t show up until the late stages of
HIV disease. If someone with a high T-cell
count develops a neurologic problem, their doctor will look
for other causes. These might include depression or the aging
process. However, a recent study found that HIV infection can
affect verbal memory, even in patients who have no other symptoms.
Tell your doctor if you have any signs of neurologic problems.
These include:
- Balance problems
- Vision problems
- Difficulty remembering
- Difficulty concentrating or completing a task
- Getting lost in places that you know
- Forgetting telephone numbers that you use a lot
- Having trouble with simple math like making change at the
store
Your doctor might use some paper and pencil tests to learn
more about what’s causing a mental slowdown.
Some neurologic problems require urgent medical attention.
If you have serious headaches, especially with a fever, stiff
neck, vomiting, or vision problems, you should see your doctor
immediately.
PROBLEMS TREATED?
CNS problems can be caused by medications, swelling, or direct
HIV infection of the brain and spinal cord.
If the problems are caused by medications, they usually go
away if you stop taking the drugs.
Problems caused by swelling, which include toxoplasmosis
(see Fact Sheet 517), can be treated with antibiotics.
HIV infection of the CNS has to be treated with antiviral drugs.
Unfortunately, the “blood brain barrier” keeps many
drugs out of the central nervous system. It’s a tight network
of blood vessels that protects the brain and spinal cord from
most germs or poisons in your blood
Several anti-HIV drugs get through the blood-brain barrier at
fairly high levels:
A special concern is that people with CNS problems may need
extra help remembering to take their medications.
Caring for someone with dementia is very difficult. Caregivers
need to take care of themselves, too, to avoid burnout and depression.
Some newer medications are being studied for mental problems.
These include memantine and lexipafant. Partly because of the
small number of people with HIV-related mental problems, these
drugs are being studied in people with other diseases.
HIV disease can cause a range of nervous system problems, from
forgetfulness and balance problems to serious dementia. These
problems usually don’t show up until the later stages of HIV disease.
However, problems with verbal memory can show up even in people
with no other symptoms.
The new combination therapies that fight HIV seem to help protect
the central nervous system against damage from the virus.
Revised March 6, 2002
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New Mexico AIDS Education and Training Center
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