Abstract

The central nervous system (CNS) is among the most frequent and main target of HIV infection in severely immunocompromised patients. Neurological manifestations occur due to either primary pathologic process of HIV or secondary to opportunistic infection. The present study was conducted to ascertain the prevalence of various neurological manifestations in HIV positive patients, correlation of CD₄ levels in CNS opportunistic infection and their outcome. This was a prospective observational study of 105 HIV infected patients with clinical evidence of CNS involvement. A detailed clinical history and CNS examination was carried out. CD₄counts was measured by flow cytometry method and other investigations like magnetic resonance imaging (MRI), brain/electromyography, nerve conduction studies and cerebrospinal fluid (CSF) examination were done as required for diagnosis. HIV induced primary illness was present in about 30% cases while 70% associated with secondary CNS manifestations were mainly due to opportunistic infection. The most common primary illness was distal symmetrical polyneuropathy (20.9%), followed by AIDS dementia complex (3.8%), acute inflammatory demyelinating neuropathy (3.8%). On the other hand, the most common secondary CNS infection was tuberculous bacterial (TBM; 32.3%), followed by cryptococcal meningitis (13.3%), progressive multifocal leukoencephalopathy (PML; 11.4%), and cerebral toxoplasmosis (9.5%). The commonest presenting symptoms of TBM were fever (72.38%), while headache and vomiting was 27.62 and 28.57%, respectively. Mean CD4 count was 172 ± 81.2 in distal symmetrical polyneuropathy (DSPN), 282 ± 75.3 in acute inflammatory demyelinating neuropathy (AIDP) and 95 ± 6.5 for AIDS dementia complex.

Key words: HIV positive patients, CD₄ count neurological manifestation.