Study of Clinical Spectrum of Neurological Manifestations in HIV/AIDS Seen at Tertiary Referral Hospital in India

Abstract

Objectives: The pandemic caused by human immunodeficiency virus (HIV) is one of the fastest growing health problems in the world today. Neurological manifestations of HIV infection and acquired immunodeficiency syndrome (AIDS) are being seen in a frequency that is parallel to the increasing number of new cases seen the world over. The World Health Organisation (WHO) estimates that 36.7 million people in the world are infected with HIV. Neurological manifestations of HIV disease can be seen in 20% of outpatients in HIV clinics and almost half of HIV patients being treated as in-patients. Of the various subtypes of HIV, subtype C is responsible for more than 50% of HIV1 infections causing rapidly growing epidemics in India. The objectives of this study were as follows: (1) To evaluate the prevalence of neurological manifestation in HIV-positive patients admitted to a tertiary referral Hospital in India. (2) To describe the neurological manifestations documented. (3) To find the possible predictors of neurological manifestations. Material and Methods: This study was a single centre prospective cross-sectional study in which out of 200 HIV/AIDS patients, 40 patients with neurological manifestations were analysed over a period of 18 months. They were interviewed and evaluated with particular reference to neurological manifestations, and were classified using the WHO staging system. Results: Amongst the studied population of 40 patients, 16 patients (40%) manifested as tuberculous meningitis (TBM) with or without brain tuberculomas, followed by seven patients (18%) presented with peripheral neuropathy and six patients (15%) presented with central nervous system (CNS) vasculitic or multi-infarct state. Cryptococcal meningitis was seen in five patients (12%), efavirenz-induced psychosis/seizure seen in one patient, while HIV-induced polymyositis, progressive multifocal leukoencephalopathy progressive multifocal leukoencephalopathy, acute inflammatory demylinating polyradiculoneuropathy, AIDS dementia complex and CNS toxoplasmosis were seen in one patient each respectively. One patient presented with dual opportunistic infection with coexistence of cryptococcal and tuberculous meningitis. Conclusion: Headache with or without vomiting, seizures and altered sensorium were the most common neurological symptoms. Fundus abnormalities, meningeal signs, gait abnormalities, cranial nerve dysfunction and hemiplegia were the most common neurological signs. New-onset headache was a significant predictor of the occurrence of neurological complications. Opportunistic infections such as TBM and Cryptococcal meningitis were most commonly observed.