Neurological Infections in HIV: A Case-Based Review for Clinicians

Central Nervous System (CNS) disease remains a significant cause of morbidity and mortality in people with advanced HIV infection. This case-based review presents eight illustrative scenarios to demonstrate a structured clinical approach to common CNS manifestations in HIV in low-resource settings. The cases cover meningeal syndromes (cryptococcal and tuberculous meningitis), focal mass-like lesions (toxoplasmosis, tuberculoma, and primary CNS lymphoma), and diffuse or multifocal white matter disorders (HIV encephalopathy, progressive multifocal leukoencephalopathy, and cytomegalovirus encephalitis). Each case highlights key clinical reasoning steps, including interpretation of neuroimaging and cerebrospinal fluid analysis, and integration of serologic and molecular diagnostics. A syndromic framework is used to classify presentations and refine the differential diagnosis based on CD4 count, rate of progression, and radiological patterns. The review also discusses principles of management, including targeted antimicrobial or oncologic therapy, timing of antiretroviral therapy initiation, and the prevention and treatment of immune reconstitution inflammatory syndrome. Through these illustrative examples, the article provides a practical, context-appropriate guide to evaluating and managing HIV-associated CNS disease, particularly in settings where diagnostic resources and access to surgical interventions may be limited.