HIV-1-associated encephalopathy and myelopathy

HIV-1-associated encephalopathy (HIVE) remains an important manifestation of advanced HIV infection despite recent progress in antiretroviral therapy. This is in part due to particular pharmacological and virological characteristics of the central nervous system (CNS). HIVE is characterized by a,,subcortical" dementia with psychomotor slowing as well as memory and concentration deficits. An invariable finding are deficits of central motor function. Pathogenetically, an enhanced viral replication in immunocompetent CNS cells is believed to be a requirement. This leads to neurotoxic effects directly elicited by viral products as well as indirectly by the immune response to virus infection. HIV-1 myelopathy (HIVM) is the other CNS manifestion of late HIV infection. The present consensus paper recommends diagnostic and therapeutic procedures in HIVE and HIVM and outlines the current research.