HIV: Neurocomplications

Key points

• Focal neurological lesions Toxoplasmosis
• accounts for around 50% of cerebral lesions in patients with HIV
• constitutional symptoms, headache, confusion, drowsiness
• CT: usually single or multiple ring enhancing lesions, mass effect may be seen
• management: PYRIMETHAMINE WITH SULFADIAZINE is the preferred regimen (BHIVA) · folinic acid (leucovorin) is given alongside to limit pyrimethamine-induced myelosuppression · usually treated empirically on imaging plus positive Toxoplasma serology, with biopsy reserved for non-responders.
• EXAM POINT: a patient already on sulfadiazine with pyrimethamine for cerebral toxoplasmosis does NOT need separate PCP prophylaxis (BHIVA Grade 1B) · cerebral toxoplasmosis typically occurs at CD4 below 100, but CD4 is a risk guide rather than a diagnostic criterion. Cerebral toxoplasmosis: CT scan with contrast showing multiple ring enhancing lesions Cerebral toxoplasmosis: MRI (T1 C+) demonstrates multiple small peripherally enhancing nodules…