Central nervous system manifestations in human immunodeficiency virus patients in the antiretroviral therapy era - Scenario from a developing country

Abstract

Background: Central nervous system (CNS) infections associated with Human immunodeficiency virus (HIV) has decreased markedly in the developed countries. However, the scenario is different in Indian patients and is not unusual to have CNS infections as their initial presentation. Considering this, we undertook this study to look at the incidence of CNS manifestations in HIV infected patients. Materials and Methods: This was a cross sectional study conducted in the Departments of Medicine and Neurology in Christian Medical College Ludhiana, a tertiary teaching institution in North West India. All the HIV infected patients with Central nervous system manifestations who presented to our institution from 1st April 2009 to 31st of March 2014 were included in the study. The demographic and clinical profile along with the outcome of these patients was studied. Results: There were 280 patients diagnosed during this 5 year period, 43(15%) of who had CNS manifestations. The male: female ratio was 5:1. Majority of them were in the age group of 31 to 50 years of age (68.89%).In 72% of patients CNS manifestations were the initial manifestation of HIV infection.The CNS manifestations noted were cryptococcal meningitis in 20, toxoplasmosis in 3, CNS tuberculosis in 11, PMLE in 6, ischemic stroke in 4 and Diffuse B cell Lymphoma (DLBCL) with aseptic meningitis in 1. Conclusions: Even though in the era of HAART the incidence of CNS manifestations has decreased, CNS manifestations continue to be the presenting symptom for HIV infection in over 16% of the cases.