Clinical Characteristics of Ecuadorian Patients with Acquired Immunodeficiency Syndrome (AIDS) and Central Nervous System Infection

Abstract

Antecedents: Infection of the central nervous system (CNS) by a variety of opportunistic agents in individuals infected with the human immunodeficiency virus (HIV) remain a major cause of morbidity and mortality. The clinical and radiographic pattern of CNS in HIV immunocompromised patients are sometimes sufficient to establish the diagnosis. The purpose of this study is to describe the etiology distribution, clinical parameters, evaluation, management and complications in a group of patients treated in a hospital’s AIDS unit from a developing country. Methodology: An observational retrospective analytical study was conducted at Eugenio Espejo Hospital, Quito-Ecuador, between April 2002 and June 2010. Results: The prevalence of CNS infections in HIV patients was 5.9%. The most common opportunistic infections were Toxoplasmosis 46%, Cryptococcosis 20%, Tuberculosis 19%, HIV Encephalopathy 5%, and Progressive Multifocal Leukoencephalopathy (PML) 5%. The main clinical manifestations were headache, fever, and neurological focality. In the first decade of the 2000s, antiretroviral therapeutic (ART) regimens were established in 84% cases of which 66% followed the guidelines for treatment-naïve patients (AZT / 3TC / EFV). The prevalence of mortality was 21.31%, being the most common fatal complications lactic acidosis (38%), Systemic Inflammatory Response Syndrome (SIRS) (38%) and Immune Reconstitution Inflammatory Syndrome (IRIS) 23%. Conclusion: The prevalence presented in our study, is comparable to other studies conducted in developing countries in the same period. The high percentages of HIV-associated opportunistic CNS infection reported by 2005 was followed by a dramatic reduction since the advent and consolidation of highly active antiretroviral therapy (HAART).