AIDS and the Nervous System

A SELECTED CASE  A 32-YEAR-OLD, healthy homosexual man was found to be seropositive for human immunodeficiency virus (HIV) on routine testing. He was in good general health. His peripheral blood lymphocyte subsets were normal. Eight months later, he noted a gradual onset of weakness and paresthesias in both legs. Weakness progressed, and within a 2-month period he became wheelchair bound. On examination, he had severe, primarily distal muscle weakness with bilateral footdrop and areflexia. Pinprick sensation was diminished below the knees and vibratory and position sensation was absent in his feet. The cerebrospinal fluid (CSF) protein level was increased to 2.12 g/L with pleocytosis. Nerve conduction velocity was slow (averaging 22 m/s), with conduction block consistent with demyelinating polyneuropathy. A sural nerve biopsy specimen showed features of segmental demyelination with perivascular inflammation. Normal results were obtained from blood chemistries, a serum immunoglobulin profile, thyroid studies, and a complete blood cell