N.S Neki

Assessment of neurological manifestations in HIV positive patients

Background: Nervous system involvement is one of the catastrophic target of human immunodeficiency virus (HIV) infection. Inspite of adequate ART (antiretroviral therapy), HIV infected individuals still experience neurological diseases. At least 40% HIV-infected patients devolp neurological symptoms during the course of their illness and in 10-20% of the patients, the presence of a neurological disease is the first manifestation of symptomatic HIV infection. Aims and Objectives: To illuminate the spectrum of neurological involvement in patients with HIV infection at Govt Medical College & Hospital Amritsar (Punjab). We evaluated various neurological manifestations of HIV including opportunistic infections (OPIs) and non-opportunistic infections (nonOPIs). Settings and Design: This was a observational study conducted at Govt Medical College & Hospital Amritsar (Punjab) over a period of 1 years from June 2016 to July 2017. Materials and Methods: The study included a total of 100 HIV seropositive patients of both genders, of age >18 years, attending the ART centre, medicine OPD, admitted in medicine ward with neurological manifestations, at Govt Medical College & Hospital Amritsar (Punjab) were studied for clinical parameters, laboratory investigations and imaging. Results: A total of 100 patients admitted with HIV infection, of which 44 patients (44%) presented with neurological manifestations were enrolled in the study. The most common age group affected was 31 to 40 years (45.4%), males were affected more than females (63.6% male patients, 36.3% female patients) and most of the patients were from rural (72.73%) areas of Amritsar. Fever (59.09%) was the most common feature. Headache in 22 patients (50%) was most common neurological complaint followed by altered sensorium in 19 patients (43%) and focal neurological deficit in 15 patients (34.09%). Tubercular meningitis in 13 patients (59.09%) followed by cryptococcal meningitis in 6 patients (27.27%) was most common cause of headache. Most common cause of altered sensorium was tubercular meningitis in 7 patients (36.8%).Tuberculosis (59.26%) was most common opportunistic infection followed by cryptococcal meningitis (25.93%) and toxoplasmosis in (14.81%) patients. Non-opportunistic neurological manifestations were present in 16 patients (36.36%), out of which cerebral infarcts in 9 patients DOI: http://dx.doi.org/10.22192/ijcrbm.2017.02.11.008 ISSN: 2455-944X Int. J. Curr. Res. Biol. Med. (2017). 2(11): 55-71 56 (56.25%) followed by HIV myelopathy in 2 patients (12.5%), primary CNS lymphoma in 2 patients (12.5%), sub-acute combined degeneration of spinal cord , peripheral neuropathy, sensory ataxia in 1 patient (6.25%) each. Conclusion: We found a high prevalence of neurological manifestations in HIV seropositive patients (44%) in this setting. Tubercular meningitis was the most common secondary infection seen in HIV patients followed by Cryptococcal meningitis. The most common non-infectious lesions included cerebrovascular events, followed by HIV myelopathy and neoplasms. Neuropathies were the least common neurological manifestations in patients with HIV infection. There must be a high index of suspicion for neurological manifestations in HIV patients presenting with neurological complaints, as most o these opportunistic infections are treatable.