Abstract
BackgroundEven though the prevalence of HIV infection among the adult population in Ethiopia was estimated to be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective study was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations.MethodsMedical records of 347 patients (age ≥13 years) admitted to Tikur Anbesa Hospital from September 2002 to August 2009 were reviewed and demographic and clinical data were collected.ResultsData from 347 patients were analysed. The mean age was 34.6 years. The diagnosis of HIV was made before current admission in 33.7% and 15.6% were on antiretroviral therapy (ART). Causes of neurological manifestation were: cerebral toxoplasmosis (36.6%), tuberculous meningitis (22.5%), cryptococcal meningitis (22.2%) and bacterial meningitis (6.9%). HIV-encephalopathy, primary central nervous system (CNS) lymphoma and progressive multifocal leukoencephalopathy were rare in our patients. CD4 count was done in 64.6% and 89.7% had count below 200/mm3[mean = 95.8, median = 57] and 95.7% were stage IV. Neuroimaging was done in 38% and 56.8% had mass lesion. The overall mortality was 45% and the case-fatality rates were: tuberculous meningitis (53.8%), cryptococcal meningitis (48.1%), cerebral toxoplasmosiss (44.1%) and bacterial meningitis (33.3%). Change in sensorium and seizure were predictors of mortality.ConclusionsCNS opportunistic infections were the major causes of neurological manifestations of HIV/AIDS and were associated with high mortality and morbidity. Almost all patients had advanced HIV disease at presentation. Early diagnosis of HIV, prophylaxis and treatment of opportunistic infections, timely ART, and improving laboratory services are recommended. Mortality was related to change in sensorium and seizure.
Highlights
Symptomatic neurologic dysfunction develops in more than 50% of individuals infected with human immunodeficiency virus (HIV) [1] and about 10% experience neurologic symptoms as the initial manifestation of acquired immunodeficiency syndrome (AIDS) [2]
Neurologic disorders associated with HIV infection include central nervous system (CNS) infections, neoplasms, vascular complications, peripheral neuropathies and myopathies [3]
Studies done in developing countries showed that the major causes of neurologic disorders in HIV/AIDS patients are CNS opportunistic infections [5,6,7,8,9,10,11,12]
Summary
Symptomatic neurologic dysfunction develops in more than 50% of individuals infected with human immunodeficiency virus (HIV) [1] and about 10% experience neurologic symptoms as the initial manifestation of acquired immunodeficiency syndrome (AIDS) [2]. In Ethiopia, the adult prevalence of HIV infection was estimated to be 2.2% in 2008 [13] but data on the pattern of neurological complications of HIV/AIDS are rare. Even though the prevalence of HIV infection among the adult population in Ethiopia was estimated to be 2.2% in 2008, the studies on the pattern of neurological manifestations are rare. The aim of this retrospective study was to assess the pattern and predictors of mortality of HIV/AIDS patients with neurologic manifestations
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