Evaluation of Central Nervous System Infections in HIV/AIDS Patients: A Seven-Year Retrospective Analysis

Abstract

Objective: We aimed to determine the frequency, type, and mortality rate of central nervous system infections (CNSI) in patients infected with the human immune deficiency virus (HIV). Methods: A total of 353 HIV/AIDS cases hospitalized in our clinic between January 2014 and March 2020 were retrospectively analyzed. Patients diagnosed with CNSI were included in the study. Epidemiological data, diagnoses, clinical, and laboratory information, and clinical progress data of the cases were collected from patient files and recorded. Variables were analyzed. Results: Thirty-four (9.6%) of 353 inpatients diagnosed with HIV/AIDS were followed with CNSI diagnosis. 88.2% of the cases were male, and the median age was 43.5 [interquartile range (IQR)= 26-62) ]. Toxoplasma encephalitis (n=7, 20.6% ), neurosyphilis (n=7, 20.6%), tuberculous meningitis (n=4, 11.8%), cryptococcal meningitis (n=4, 11.8%), HIV encephalopathy (n =3, 8.8%), progressive multifocal leukoencephalopathy (PML) (n=3, 8.8%), and bacterial meningitis (n=2, 5.9%), and 1 case of herpes simplex virus (HSV) encephalitis, varicella zoster virus (VZV) encephalitis, chronic encephalitis, cytomegalovirus (CMV) meningoencephalitis were seen. The median CD4+ T lymphocyte count of the cases was 44.5 /uL (IQR=5-627), HIV RNA level was 215 000 copies/mL (IQR=20-617 000) in patients under antiretroviral therapy (ART), 227 500 (IQR=32 000-4 500 000) copies/ml in patients not receiving ART. CD4+ T lymphocyte count of 25 (73.4%) patients was <200/uL. Twenty-one patients (61.8% ) were simultaneously diagnosed with HIV/AIDS and CNSI, and 14 were in the AIDS stage. The mortality rate was 32.4 % (n=11), and all fatal cases had CD4+ T lymphocyte counts below 200/uL. Conclusion: Central nervous system infections continue to cause severe mortality and morbidity in HIV-infected individuals. We observed that the frequency and mortality rate of CNSI is higher in patients who do not know their HIV status, late-presenters, and those who are not under treatment and/or do not adhere to treatment. Facilitating access to diagnostic tests, rapid treatment initiation, and counseling on treatment compliance is essential to prevent CNSI and, thus, reduce mortality.