ABSTRACT
Background: neurological manifestations affecting the nervous system at all stages of Human Immunodeficiency Virus [HIV] infection are common. Neurological complications occur in more than 40% of patients with HIV infection. They are the presenting feature of Acquired Immune Deficiency Syndrome [AIDS] in 10-20% of cases. At autopsy the prevalence of neuropathological abnormalities is 80%. Although an ongoing decline in HIV associated Central Nervous System [CNS] diseases has been observed in very recent years, the mortality from these diseases remains high
Objective: to study the type and frequency of different neurological involvements in patients with HIV infection at tertiary care hospital in Peshawar, KPK and to correlate them with CD4 counts
Study design, settings and duration: this retrospective observational study was carried at Lady Reading Hospital, Peshawar, KPK, Pakistan over a period of 8 years from May 2009 to June 2017
Subjects and Methods: a total of 100 HIV sero-positive patients of both genders, aged >18 years, showing clinical evidence of central nervous system [CNS] involvement were included. Their clinical manifestations, laboratory investigations, and neuroimaging were studied. Laboratory investigations along with magnetic resonance imaging [MRI], EEG and nerve conduction study of the brain/spine was also performed
Results: tuberculous meningitis was the most common presentation as secondary CNS illness [49%], followed by cryptococcal meningitis [16%] and cerebrovascular accidents [7%]. Furthermore, 6% had neurosyphilis, 5% had acquired immune deficiency syndrome [AIDS] associated dementia and peripheral neuropathy occurred in 17% of the patients. Headache was the most common neurological symptom seen in 42% of the patients. Seizures were noted in 35% of the patients. CD4 was significantly low in most of the patients with progressive multifocal leukoencephalopathy, HIV associated encephalopathy [HAD] and cryptococcal meningitis compared with other neurological manifestations. CD4 counts in tuberculous meningitis and HIV associated encephalopathy were 115/microl and 83/microl, respectively
Conclusion: CNS tuberculosis was the most common secondary infection seen in HIV patients followed by cryptococcal meningitis. A high index of clinical suspicion of neurological involvement in HIV patients helps in the early diagnosis and early institution of specific treatment, which in turn decreases the morbidity and mortality considerably. Early treatment and prophylaxis of neurological problems in HIV patients is very important to decrease the mortality rate