HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study

Henry Namme Luma,Alfred Kinyuy Njamnshi,Daniela Pamela Ntchankam Ndenga,Benjamin Clet Nguenkam Tchaleu,Vincent-De-Paul Djientcheu,Yacouba Njankouo Mapoure,Marie Solange Doualla,Elvis Temfack

doi:10.1155/2013/709810

Abstract

Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was 38.1 ± 13.5 years, and median CD4 count was 49 cells/mm3 (interquartile range (QR): 17–90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

Highlights

HIV infection is a major cause of morbidity and mortality worldwide and affects 33 million people of whom two-thirds live in sub-Saharan Africa [1]
The overall mortality in our study population was 49% (147) with bacterial meningitis and Primary central nervous system lymphoma (PCNSL) which are responsible for the highest case fatality rates (Table 4); men being more likely to die than women
Low CD4 count, the presence of headache, focal signs, seizures, and signs of meningeal irritation are associated with death, but this association disappeared after adjusting for sex and low CD4 cell count (Table 5)

Summary

Introduction

HIV infection is a major cause of morbidity and mortality worldwide and affects 33 million people of whom two-thirds live in sub-Saharan Africa [1]. Its predilection for the nervous system makes it neuroinvasive, can enter the central nervous system (CNS), neurotropic, can live in neural tissues and neurovirulent, and can directly cause disease of the nervous system [2, 3]. This complex HIV-nervous system interaction makes neurological manifestations a frequent complication of HIV. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality

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Discussion

Conclusion