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HTLV-1 and HIV infections of the central nervous system in tropical areas
  1. P Cabrea,
  2. D Smadjaa,
  3. A Cabiéb,
  4. C R J C Newtonc
  1. aDepartment of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies, bDepartment of Internal Medicine, University Hospital of Fort-de-France, Martinique, French West Indies, cNeuroscience Unit, Institute of Child Health, London, UK
  1. Dr D Smadja, Neurology Department, University Hospital of Fort-de-France, BP 632, 97 261 Fort-de-France Cedex, Martinique, French West Indies

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In tropical areas, the human T lymphotropic virus type 1 (HTLV-1) infection is often superimposed on the human immunodeficiency virus (HIV) endemic. However, from a clinical point of view, the neurological consequences of HTLV-1 infection are not as prevalent as those of HIV infection. Only 0.25% of the HTLV-1 carriers develop a progressive myelopathy.1 By contrast, CNS complications of HIV infection are frequent and often lethal. Most (89%) of the 30.6 million HIV infected people are estimated to live in sub-Saharan Africa and developing countries of Asia,2 but the neurological complications have been well described in other populations. By contrast, HTLV-1 infection is mostly confined to tropical areas. This review highlights the differences in the neurological complications of HIV infection, and the management of these complications in tropical countries from other parts of the world, and discusses HTLV-1 infections.

HIV infection

Neurological disorders complicate HIV infection in 30% to 40% of patients, and any part of the neuraxis may be affected.3 4 Furthermore, some studies have shown neuropathological abnormalities in 75% to 90% of patients dying with AIDS.3 5-7 In tropical countries CNS abnormalities are also frequent in clinical and postmortem studies.6-14Early CNS infection is usually asymptomatic or responsible for rare disorders such as acute aseptic meningitis or encephalitis.15 16 During the later stages of infection both the major CNS opportunistic infections and AIDS dementia complex develop.4 17 Since 1996, the use of highly active antiretroviral therapy has decreased morbidity and mortality in HIV infected patients with advanced disease.18 19 Incidence rates of neurological manifestations such as HIV associated neuropsychological impairment and opportunistic infections seem to have declined.20-22 Unfortunately, in most tropical countries, antiretroviral therapy is not available and diagnostic tools are often limited. Although difficult to determine, the prevalence of neurological …

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