A study of clinical profile of HIV positive patients with neurological manifestations

Abstract

Background Central nervous system (CNS) is among the most frequent and serious target of HIV infection in patients with profound immunosuppression. CNS problems occur mainly due to either primary pathologic process of HIV or secondary to opportunistic infection and neoplasm. Aims and objectives To study the clinical and investigation profile in diagnosis of HIV patients with CNS manifestation. To correlate CD 4 levels with CNS opportunistic infections. Materials and methods A prospective observational non-randomized clinical study of 50 HIV infected patients, showing clinical evidence of CNS involvement, admitted in tertiary care centre was done. Detail clinical history and CNS examination was carried out. CD 4 count was measured using standard flowcytometry. Investigations like MRI brain/electromyography-nerve conduction studies/cerebrospinal fluid (CSF) examination were done as and when required for diagnosis. Results HIV induced primary CNS illness was present in 30% while 70% cases were due to secondary CNS manifestation mainly due to opportunistic infection. Most common primary illness was distal symmetric polyneuropathy (DSPN) (22%), followed by Aids dementia complex (ADC) (4%) and acute inflammatory demyelinating polyneuropathy (AIDP)(4%). tuberculous meningitis (TBM) was the most common presentation as secondary CNS illness (34%), followed by cryptococcal meningitis (14%), toxoplasmosis (10%), progressive multifocal leucoencephalopathy (PML) (8%) and neurosyphilis (4%). Meningitis was presenting CNS manifestation in majority of patients. The commonest presentation of TBM was fever (64%), while headache for cryptococcal meningitis (71%) and seizures was that of toxoplasmosis (80%). Mean CD 4 count was 170 ± 80.1 in patients of DSPN, 131 ± 85.75 for TBM, 47.5 ± 36.8 for cryptococcal, 160 ± 77.4 for toxoplasmosis and 93 ± 65 for ADC. Conclusion High degree of clinical suspicion of nervous involvement in HIV patients at all stages help in early diagnosis and institution of specific therapeutic measures which in turn decrease mortality and morbidity.