Neurological complications of human immunodeficiency virus infection in Zimbabwe-2005.

Zimbabwe is a high prevalence area for HIV infection, and provides opportunities for studying complications of AIDS in both antiretroviral naive and treated groups of patients. Figures for HIV prevalence are among the highest in the world, but the number of people receiving treatment is very small. Economic and political factors contribute to this important health crisis. Opportunistic diseases as a whole and their relative frequencies of presentation in southern Africa are discussed, emphasizing the lead role of tuberculosis. The limited data that do exist regarding neurological complications in Zimbabwe are summarized, and combined with anecdotal experience from practicing clinicians. Opportunistic infections in the nervous system are very common, the most important being cryptococcal meningitis, causing half of all adult meningitis in the country. Tuberculous and bacterial meningitis have also become more common and carry a high mortality in HIV-infected people in Zimbabwe. Intracranial mass lesions, including tuberculoma, bacterial abscesses and toxoplasmosis encephalitis are less common and difficult to diagnose in the absence of stereotactic biopsy. Spinal tuberculosis and transverse myelitis are the most frequent causes of spinal cord opportunistic infections. Peripheral neuropathy is probably similar in presentation to that seen elsewhere, whereas dementia is less frequently recognized.