1st August 2023

Other Complications of HIV

Neurological complications

AIDS-dementia complex (ADC) is a type of dementia seen in HIV patients and commonly associated with cerebellar features. Clinical presentation can range from mild memory impairment to severe cognitive decline and personality change, and psychotic features may be seen. Diagnosis is supported by MRI head scans showing white matter lesions and encephalopathic features on EEG.

HIV is also associated with sensory neuropathies, which typically cause an intensely painful symmetrical sensory neuropathy of the feet, which may progress to the upper limbs. HIV is also associated with autonomic neuropathy, which mainly presents with postural hypotension and diarrhoea.

Haematological complications

Haematological complications are more frequent as HIV progresses and are associated with a falling CD4 count. Associated conditions include lymphopenia, anaemia (classically normocytic and normochromic), neutropenia, thrombocytopenia, and pancytopenia.

Metabolic and endocrine complications

Adrenal gland dysfunction and testosterone deficiency are associated with HIV.

Osteopenia, osteoporosis and avascular necrosis are all associated with HIV, with ART also implicated in the aetiology.

Cardiovascular complications

Lipid dysfunction is associated with ART, meaning HIV patients are more at risk of cardiovascular disease as a therapeutic side effect. Data also suggests that ischaemic heart disease is more common in untreated HIV patients, and there is a risk independent of treatment side effects.

Cardiomyopathy and myocarditis are also associated with HIV.

Renal complications

Renal disease in HIV is known as HIV-associated nephropathy (HIVAN). Nephrotic syndrome secondary to focal segmental glomerulosclerosis is the most common renal disease in HIV. It causes a severe, progressive illness, and dialysis is often indicated. HIVAN is most common in male patients and patients with African-American heritage.