Characteristics of HIV-associated diseases of the central nervous system in hospitalized patients in the Dnipropetrovsk region

Abstract

Objective — to analyze the main epidemiological, demographic and laboratory characteristics of cases of HIV associated diseases of the central nervous system (CNS) in the Dnipro city and Dnipropetrovsk region in the period 2010—2017.Materials and methods. A retrospective cohort analysis of medical records of 451 patients with HIV-associated diseases of the CNS hospitalized in the departments of the municipal clinical hospital N 21 (Dnipro city) and the Dnipropetrovsk regional center for the prevention and control of AIDS (Ukraine) (2010—2017). The statistical processing of the results was carried out using the STATISTICA v.6.1® software package.Results and discussion. Among 451 patients with HIV-associated diseases of the nervous system, the majority were men — 263 (58.3 %). The mean age was (38.6 ± 0.37) years. 260 (57.6 %) patients survived, 191 (42.4 %) patients died as the result of the disease. Among the deceased there we remoremales — 66.0 % versus 52.7 % (p = 0.005 FET). In 44.1 % of patients, HIV status was establishedless than a year before the neurological manifestations, mostly in patients who died — 118 (61.8 %) compared to 81 (31.2 %) (p < 0.001 FET) of survivors. Only 32 (16.8 %) of 191 deceased patients received ART. 139 (30.8 %) were sexually infected, and 184 (40.8 %) were parenteral infected as injecting drug users (IDUs). In 128 (28.4 %) cases — the path of infection was not determined. 91 patients (20.2 %) had comorbidity in CNS, 56 (61.5 %) of these patients died. Co-infection of the CNS was more of ten represented by a combination of tubercu­losis (TB) with fungal meningoencephalitis — 27 cases (29.7 %). This combination of diseasesled to anincreaseinthenumberofdeaths: 19 of 27 patientsdied (70.4 %, p = 0.006 FET). The CD4 median in the presence of HIV-associated CNS diseases was 49.0 (IQR 20.0—101.0), in deceased patients 40.0 (IQR 15.0—73.0) cells/μLvs. 61.0 (IQR 25, 0—129,0) cells/μL in those who survived (p < 0.001 by the U-test). The media of the viral load of HIV RNA is 115 007 HIV RNA copies/mL (IQR 180—521 625), with a higher level in deceased patients — 5.65 (IQR 5.15—6.05) Lg cop/ml (p < 0.001 U). The average protein content in CMP was (0.48 ± 0.03) g/L, glucose — (2.48 ± 0.06) mmol/L. Differences between the average protein and glucose levels in deceased patients and those who survived, respectively, were (0.54 ± 0.05) g/L and (2.32 ± 0.09) mM/L versus (0.42 ± 0.04) g/L and (2,63 ± 0.09) mmol/L (p = 0.066 t and p = 0.016 t). Among HIV-associated CNS lesions, TB predominated (37.3 %), cerebral toxoplasmosis (30.2 %), and fungal CNS (mycosis) lesions (16.2 %). With the development of the inflammatory syndrome of restoration of the immune system, four cases of toxoplasmosis, 2 — TB, 2 — co-infections of TB and toxoplasmosis, 2 — CMV encephalitis and 1 — encephalitis is of unspecified etiology were associated.Conclusions. The most common infectious diseases of the CNS among hospitalized patients in the Dnipropetrovsk region over the past 8 years were tuberculosis, toxoplasmosis, and fungal infections. In 20.2 % of cases there was a combination of CNS diseases, which greatly complicates the management of patients. Laboratory data for HIV-associated diseases of the CNS have significant differences depending on the consequences of the disease, which can be useful for predicting this pathology.