The neurological manifestations of HIV infection

Background and Objectives: HIV/AIDS has posed many unprecedented challenges. It causes a wide spectrum of disease manifestations. Approximately 60 % of the AIDS patients have neurological symptoms and 80-90 % have neuropathological abnormality at biopsy. The pattern of neurological complication in HIV infection in India is different from that of western countries. This study was under taken to, 1. Study the neurological manifestations in HIV patients admitted in to VIMS Hospital, Bellary. 2. To note differences with various studies carried out in western countries. Methods: Patients admitted in VIMS Hospital between December 2010 to June 2012 with symptoms referring to nervous system were screened and confirmed to have HIV-1 and/or HIV-2 infection (seropositive) by ICTC (Trispot test,Trilene test,Dot immunoassay )were enrolled if they met the inclusion criteria. Results: 58 of the 547 HIV positive patients fulfilled the inclusion criteria and were studied for neurological manifestations (10.6 %). 39 were males and 19 females and mean age of 34 yrs. in males and 29yrs in females. 62.1% were presenting with neurological symptoms and signs for the first time and were diagnosed HIV positive following admission. Meningitis was the commonest presentation (81.1%), 35(60.3%) patients with tubercular, 9(15.1%) patients with cryptococcal aetiology and 3(5.1%) had bacterial meningitis. Altered sensorium (75.6%), Headache (51.3 %), convulsions (32.4%) and focal neurological deficit (21.6 %) were the commonest presenting neurological symptoms with fever in 89.1 % of all cases. Tubercular involvement in form of meningitis (60.3%) and intracranial space occupying lesion (Tuberculoma) in 2 patients (3.4%) was the single largest etiological agent followed by cryptococcal meningitis 15.1%, 5 patients had CVA, 3 had bacterial meningitis, 2 had myelopathy, 1 had Bell’s palsy and 1 patient had Guillain-Barre syndrome. No case of toxoplasmosis or lymphoma was detected. Interpretation and Conclusion : There is high incidence of neurological manifestations with tuberculosis and Cryptococci being commonest pathogenic agents in course of HIV infections in this study. Simple investigations like CD4 count may provide a clue to the degree of underlying immunosuppression and indicate the need to start ART in HIV/AIDS patients.