What is cytomegalovirus (CMV) encephalitis in HIV?

Updated: Jan 08, 2020
  • Author: Regina Krel, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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HIV-associated cytomegalovirus (CMV) encephalitis is one of several central and peripheral nervous system infections seen in late-stage disease. [1] Neurologic manifestations of CMV infection include encephalitis, ventriculitis, myelitis, retinitis, radiculoganglionitis, and peripheral neuropathies. These infections usually occur in patients with severe immunodeficiency: CD4+ lymphocyte counts typically are lower than 50/µL.

Prior to the development of highly active antiretroviral therapy (HAART), 2% of HIV-infected patients with CD4+ counts less than 50/µL developed CMV neurologic disease. The incidence has decreased since HAART became available. CMV infection of the CNS is recognized at autopsy in 18-28% of patients with AIDS. Histologic findings include ventriculoencephalitis, microglial nodules, focal parenchymal necrosis, isolated cytomegalic cells, and nuclear inclusions.

Cerebrospinal fluid (CSF) analysis not only can point to the correct diagnosis but also permits exclusion of other diagnostic considerations. Prompt initiation of antiviral drugs is essential. If left untreated, HIV-associated CMV encephalitis typically progresses to death in days to weeks. Death may result from other complications of advanced AIDS rather than the neurologic condition.

Encephalitis and meningitis have different but overlapping clinical features. Patients with meningitis may be lethargic or distracted by headache, but cerebral function usually remains normal. Patients with encephalitis commonly present with altered mental status, motor or sensory deficits, altered behavior, personality changes, and speech or movement disorders. 

For more information, see the Medscape Reference topics HIV Disease, Encephalitis, Cytomegalovirus, and Viral Encephalitis.

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