Neurological complications in late-stage hospitalized patients with HIV disease

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Date: July-September 2011
From: Annals of Indian Academy of Neurology(Vol. 14, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 3,954 words
Lexile Measure: 1700L

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Byline: Rakendra. Singh, Manjot. Kaur, Deepak. Arora

Background and Objective: The nervous system is the most frequent and serious targets of human immunodeficiency virus (HIV) infection. In spite of a wide prevalence of neurological manifestations in HIV there are not many studies to look into it, especially from this part of the world. We investigated various neurological manifestations of HIV and their association with CD4 and CD8 counts at the time of presentation. Materials and Methods: All HIV-infected patients who presented to 750 bedded teaching hospital in North India were subjected to thorough neurological and neuropsychological evaluation. Wherever indicated, neuroimaging, cerebrospinal fluid study, electromyography, and nerve-conduction studies were performed to confirm the diagnosis. CD4 and CD8 counts were calculated. Results: A total of 416 HIV-positive patients were seen. Of them 269 were males. A total of 312 neurological events were identified in 268 patients having evidence of neurological involvement. HIV-associated dementia (HAD) was the most common cause of morbidity (33.65%), followed by CNS infections (21.63%). Most common CNS infection was tuberculosis (65.56%). CD4 counts in CNS infections and HAD were 64.8/ml and 83.52/ml, respectively. Most of the patients in our study had low scores on MMSE (22.32). Conclusions: Even in the absence of overt neurological disease, subclinical involvement in the form of subtle cognitive and motor decline is found to occur with greater frequency. Most of these patients have lower CD4 and CD8 counts, thus substantiating the proposition that neuroAIDS is a late manifestation. Significant correlation exists between CD4 counts and type of neurological manifestation. We concluded that neuropsychological assessment should be mandatory for all HIV-positive patients.

Introduction

The nervous system is among the most frequent and serious targets of human immunodeficiency virus (HIV) infection. 40% to 70% of all persons infected with HIV develop symptomatic neurological disorders. [sup][1] Although nervous system involvement typically occurs with profound immunosuppression and in the presence of other acquired immunodeficiency syndrome (AIDS) defining illnesses, yet in 10% to 20% of HIV seropositive persons it heralds AIDS.

The nomenclature of HIV-related neurological diagnoses was recently revised and updated. [sup][2],[3] The neurological complications of AIDS (NeuroAIDS) include neurocognitive impairment and HIV-associated dementia (HAD; also known as AIDS dementia and HIV encephalopathy). HAD is the most significant and devastating central nervous system (CNS) complication associated with HIV infection. [sup][4] Less seriously afflicted patients manifest a milder form of HIV-associated impairment known as HIV-associated minor cognitive/motor disorder (MCMD).

In spite of the wide prevalence of neurological manifestations in HIV there have not been many studies to look into this aspect of the disease especially in the resource-limited communities in Sub-Saharan Africa, Asia, and the rest of the developing world.

Materials and Methods

The study was conducted over a 4 year prospective period and included all patients who satisfied the inclusion criteria (>18 year of age; HIV positive; any gender) from 1 January 2006 to 31 December 2009 and were admitted to the hospital medical unit or were referred to the outpatient department of Adesh Institute of Medical Sciences...

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Gale Document Number: GALE|A269495110