Neuro-HIV

Abstract

It is estimated that 35 million people are infected with HIV globally of whom >70% live in SSA. Neurological disorders (NDs) are common affecting at least 70% of HIV infected persons in SSA. They are caused mostly by opportunistic infections (OIs) and primary HIV infection. The main CNS/OIs (24%) are meningitis (14%) and focal brain lesions (10%). Primary HIV infection of the nervous system mainly results in HIV associated neurocognitive disorders (HAND) (49%), neuropathy (52%) and vacuolar myelopathy (16%). Neuropathies arising from autoimmune based inflammation also occur butare uncommon (<1%). The main causes of meningitis are: cyrptococcus (CM) 52%, tuberculous meningitis(TBM) 20%, acute bacterial meningitis (ABM) 14% & others 14%. Focal brain lesions are caused mostly by infections: toxoplasmosis (9%) and tuberculosis (1%). In 2013, a total of 1.5 million deaths from HIV were reported globally, of which 1.1 million were from SSA. The leading causes were tuberculosis: (pulmonary/systemic), pneumonia and bacteraemia (>40%) followed by CNS/OIs (20-25%). The case fatality rate (CFR) in treated HIV/meningitis is 62-69% with approximately 10% reduction post ART in CM and TBM and no reduction in ABM. CFR in treated toxoplasmosis is 22%. The immune reconstitution inflammatory syndrome (IRIS) occurs in CM 21% (13-45%) and in TB 12% (5-47%) in ART treated patients. The excess mortality attributable to IRIS in CM is 20% (13-36%) and TBM is 30% (13-70%).Conclusion: CNS/OIs are a leading causes of death in HIV in SSA. Contributory causes include advanced immunosuppression, late clinical presentation, IRIS and concurrent systemic tuberculosis. It is estimated that 35 million people are infected with HIV globally of whom >70% live in SSA. Neurological disorders (NDs) are common affecting at least 70% of HIV infected persons in SSA. They are caused mostly by opportunistic infections (OIs) and primary HIV infection. The main CNS/OIs (24%) are meningitis (14%) and focal brain lesions (10%). Primary HIV infection of the nervous system mainly results in HIV associated neurocognitive disorders (HAND) (49%), neuropathy (52%) and vacuolar myelopathy (16%). Neuropathies arising from autoimmune based inflammation also occur butare uncommon (<1%). The main causes of meningitis are: cyrptococcus (CM) 52%, tuberculous meningitis(TBM) 20%, acute bacterial meningitis (ABM) 14% & others 14%. Focal brain lesions are caused mostly by infections: toxoplasmosis (9%) and tuberculosis (1%). In 2013, a total of 1.5 million deaths from HIV were reported globally, of which 1.1 million were from SSA. The leading causes were tuberculosis: (pulmonary/systemic), pneumonia and bacteraemia (>40%) followed by CNS/OIs (20-25%). The case fatality rate (CFR) in treated HIV/meningitis is 62-69% with approximately 10% reduction post ART in CM and TBM and no reduction in ABM. CFR in treated toxoplasmosis is 22%. The immune reconstitution inflammatory syndrome (IRIS) occurs in CM 21% (13-45%) and in TB 12% (5-47%) in ART treated patients. The excess mortality attributable to IRIS in CM is 20% (13-36%) and TBM is 30% (13-70%). Conclusion: CNS/OIs are a leading causes of death in HIV in SSA. Contributory causes include advanced immunosuppression, late clinical presentation, IRIS and concurrent systemic tuberculosis.