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HIV neurology
  1. G Fuller

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    B J Brew. Oxford University Press, New York, 2001, £75.00, pp 252. ISBN 0-19-513363-3

    Do we need books anymore? I found myself asking this rather shocking question when an exceptionally keen medical student brought a series of current reviews relating to a patient we had seen in clinic together, downloaded from the internet within minutes of the clinic ending. HIV neurology provides at least one rationale for book publishing. Given the epidemiology of HIV in the UK, most neurologists will encounter HIV associated neurological problems rarely. Most of the physicians who look after patients with HIV disease are familiar with common neurological problems. Neurologists will therefore tend to find themselves either considering HIV associated disease as part of the differential diagnosis in patients whose HIV status is not known, or being asked for opinions once more straightforward HIV complications have been considered. This book seems to have been designed with this in mind and is organised to allow ease of reference.

    The first section provides an overview of HIV disease with a succinct and accessible summary of the virology, with an outline of general treatment. The approach to neurological diagnosis is explored including useful concepts to help neurologists abandon Occam’s razor, as they must in HIV disease. These include “time locking”, the linking of the potential complication to the stage of HIV infection; “parallel tracking”, the recognition that multiple levels of the nervous system can be involved in the same disease process to confuse the clinical presentation; and “layering”, the idea that multiple pathologies can affect the same level of the nervous system. The subsequent sections are based on the levels of the nervous system affected: predominantly non-focal complications relating to the brain; focal complications; spinal cord; peripheral nerve; and finally muscle. Each section discusses the many complications on conventional lines, epidemiology, clinical features, investigations, neuropathology, pathogenesis, and treatment. These are well referenced and throughout there is strong feeling that they have been written by someone with an extensive practical experience of the clinical problems described.

    Reading the book in the usual way I did find some repetition, but this is an unfair criticism as the book is intended for reference section by section. There is also an assumption that somehow all neurological symptoms suffered by patients with HIV are in some way related to HIV and that they are immune to more conventional problems. The section on “HIV headache”, a commonly occurring throbbing headache for which no cause is found and which anecdotally responds to amitriptyline, which in other clinics seems familiar enough, perhaps best illustrates this.

    These minor gripes aside I think this is a useful book, although expensive at £75. It is much more than the sum of the references within it as it brings a thoughtful integration of the clinical approach to patients with HIV neurology. For most neurologists this book will beat the internet.

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