Disease spectrum and prognostic factors of 499 cases of acquired immune deficiency syndrome complicated with central nervous system infections in Chongqing

Abstract

Objective To describe the disease spectrum, morbidity, mortality and prognostic factors of acquired immune deficiency syndrome (AIDS) patients complicated with central nervous system (CNS) infections. Methods The data of 4 426 AIDS patients from February 2013 to February 2017 in Chongqing public health medical center were collected, among which 499 cases had CNS infection. The morbidity and mortality of CNS infections were calculated. Association between different CNS infections and CD4+ T cell counts was analyzed. Prognostic factors for the outcome of hospitalization were also studied. Mann-Whitney U test was used for continuous variables. Univariate and multivariate analyses were performed by logistic regression analysis. Results The morbidity of CNS infections in AIDS patients was 11.27% (499/4 426). The most prevalent CNS infections were tuberculous meningitis (4.50%), cryptococcal meningitis (3.25%) and CNS infections with unknown etiology (1.11%). The mortality rate was 18.84% (94/499), among which tuberculous meningitis accounted for 35 cases (17.59%), cryptococcal meningitis 23 cases (15.79%) and CNS infections with unknown etiology 19 cases (38.76%). The average CD4+ T cell count level in those who died were significantly lower than that in those who survived (Z=-2.51, P=0.001). Visual impairment, nuchal rigidity, positive pathologic reflexes, consciousness disturbance, CD4+ T cell counts<50 cells/μL and HIV RNA≥5 lg copies/mL at baseline were independent prognostic factors for mortality. Conclusions The morbidity and mortality of CNS infections are high among AIDS patients in Chongqing, and those patients with severe immunosuppression are usually affected. Older age, consciousness disturtance and severe immunosuppression are three independent risk factors for mortality. Key words: Acquired immune deficiency syndrome; Central nervous system disease; Disease spectrum; Retrospective analysis