Opportunistic neurologic infections in patients infected with human immunodeficiency virus

Neurologic opportunistic infections in individuals with human immunodeficiency virus remain significant causes of morbidity and mortality despite the availability of highly active antiretroviral therapy. These pathogens are generally ubiquitous or are very commonly acquired by humans but reactivate during periods of profound immunosuppression. Diagnosis can be very challenging, relying on a combination of recognition of clinical syndromes, radiographic findings, and cerebrospinal fluid analysis. Newer molecular tests provide means for diagnosis at times when culture-based diagnosis is limited. With experience, guidance in treating these infections has been published focusing on therapies and immune reconstitution utilizing antiretroviral therapy. Prevention of these neurologic infections relies mostly on restoring or preserving cell-mediated immunity but can be enhanced in a few by avoidance of primary infection, treatment, or suppression of infection and at times screening for early detection and treatment.