Human immunodeficiency virus associated central nervous system infections

Török, M. Estée

doi:10.1111/j.1474-7766.2005.00345.x

Cited by 3 publications

(5 citation statements)

References 162 publications

(198 reference statements)

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“…In contrast to previous studies [19] , [31] , [33] , patients in the current study often had a high CSF cell count, with neutrophil predominance. Such findings are more commonly associated with acute bacterial meningitis and may mislead clinicians, resulting in a delayed or missed diagnosis of TBM.…”

Section: Discussioncontrasting

confidence: 95%

“…The CSF smear and culture positivity rates were also higher than those reported from previous studies of HIV-associated TBM [19] , [28] , [31] , [34] , [35] . This may be because the CSF smears were performed, using large volumes of CSF (5–10 mls) by a dedicated technician in a research laboratory.…”

Section: Discussioncontrasting

confidence: 68%

“…Although antiretroviral therapy (ART) is recommended for all HIV patients presenting with TB, the optimal time to initiate ART is unknown [19]. Two retrospective studies have shown that starting ART early in severely immunosuppressed patients with TB is associated with decreased mortality and a lowering of rates of progression [20], [21].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of HIV-associated TB is similar to TB in HIV-negative patients with some important differences; these include the drug interactions between rifamycins and antiretrovirals, paradoxical reactions or immune reconstitution inflammatory syndrome (IRIS) [14] – [17] and the potential to develop rifamycin resistance with highly intermittent therapy [18] . Although antiretroviral therapy (ART) is recommended for all HIV patients presenting with TB, the optimal time to initiate ART is unknown [19] . Two retrospective studies have shown that starting ART early in severely immunosuppressed patients with TB is associated with decreased mortality and a lowering of rates of progression [20] , [21] .…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults

et al. 2008

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MethodsThe aim of this prospective, observational cohort study was to determine the clinical and microbiological features, outcome, and baseline variables predictive of death, in Vietnamese adults with HIV-associated tuberculous meningitis (TBM). 58 patients were admitted to the Hospital for Tropical Diseases in Ho Chi Minh City and underwent routine clinical and laboratory assessments. Treatment was with standard antituberculous therapy and adjunctive dexamethasone; antiretroviral therapy was not routinely available. Patients were followed up until the end of TB treatment or death.ResultsThe median symptom duration was 11 days (range 2–90 days), 21.8% had a past history of TB, and 41.4% had severe (grade 3) TBM. The median CD4 count was 32 cells/mm3. CSF findings were as follows: median leucocyte count 438×109cells/l (63% neutrophils), 69% smear positive and 87.9% culture positive. TB drug resistance rates were high (13% mono-resistance 32.6% poly-resistance 8.7% multidrug resistance). 17% patients developed further AIDS-defining illnesses. 67.2% died (median time to death 20 days). Three baseline variables were predictive of death by multivariate analysis: increased TBM grade [adjusted hazard ratio (AHR) 1.73, 95% CI 1.08–2.76, p = 0.02], lower serum sodium (AHR 0.93, 95% CI 0.89 to 0.98, p = 0.002) and decreased CSF lymphocyte percentage (AHR 0.98, 95% CI 0.97 to 0.99, p = 0.003).ConclusionsHIV-associated TBM is devastating disease with a dismal prognosis. CSF findings included CSF neutrophil predominance, high rates of smear and culture positivity, and high rates of antituberculous drug resistance. Three baseline variables were independently associated with death: increased TBM grade; low serum sodium and decreased CSF lymphocyte percentage.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and Microbiological Features of HIV-Associated Tuberculous Meningitis in Vietnamese Adults

et al. 2008

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“…Despite the introduction of HAART, mortality for NT remains as high as 20-60 % within 1 year of diagnosis [16,20,31]. In our population, the mortality was higher in the first 8 months and stabilized thereafter.…”

Section: Discussionmentioning

confidence: 66%

Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study

et al. 2015

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The introduction of highly active anti-retroviral therapy (HAART) led to a radical change in the natural history of HIV infection and of the associated neurological opportunistic infections. However, the mortality of central nervous system (CNS) complications and opportunistic infections is still high in untreated HIV-infected individuals or in patients unaware of their HIV infection. We describe the outcome of HIV-infected patients followed at a single center for AIDS-related neurological syndromes in the 16 years following the introduction of HAART, and compare the findings with those in patients admitted up to 1996. We have conducted a retrospective study of patients with HIV infection or AIDS (based on WHO criteria and classified according to the 1993 CDC criteria) admitted during 20 years (January 1992 to March 2012) to the Infectious Diseases Unit of the University of Verona for the presence of focal or widespread CNS lesion on neuroimaging. Clinical history, CD4 cell count, HIV-RNA level, neurological examination, imaging, cerebrospinal fluid examination and eventual cerebral biopsy results were reviewed as well as the final neurological diagnosis and the treatment. The survival time from the clinical onset of the neurologic syndrome to death was calculated for each patient who died. A statistical analysis was performed comparing data collected up to and after 1996, i.e., before and after HAART introduction. Among 1043 patients with HIV infection or AIDS admitted to the Infectious Diseases Unit of the University of Verona between January 1992 and March 2012, 114 had a CNS lesion. The following diseases were observed: neurotoxoplasmosis (NT), progressive multifocal leukoencephalopathy), primary central nervous system lymphoma (PCNSL), the severe form of HIV-associated neurocognitive disorder, cryptococcal encephalitis (CE) and lesions of undetermined origin. The follow-up period was 4 weeks to 72 months both in the pre-HAART and HAART era. Cerebral lesions were detected in 53/243 patients (21.8%) in the pre-HAART era and in 61/801 patients (7.6%) in the HAART era (p < 0.001). Most patients who developed a neurological complication in the HAART period (40/59, 67.8%) were untreated or did not know to be HIV-infected; in particular, 27.9% of patients with a CNS lesion in the HAART era were unaware of their HIV infection vs 13.2% in the pre-HAART era (p < 0.05). Some patients were not virologically suppressed (14/59, 23.7%) or were immunological non-responders (undetectable viral load, with CD4 count <200 cells/μL; 4/59, 6.8%). Other statistically significant data were the mean age at the onset of neurological complications (32.6 ± 5.4 years in the pre-HAART, 40.3 ± 9.5 in the HAART group, p < 0.001) and the mean CD4 cell count at the onset of illness (median of 38 cells/µL (2-215) in the pre-HAART, 77 cells/µL (2-752) in the HAART group; p < 0.001). In the HAART era a reduction of PCNSL and NT was observed. Our results, while confirming a decrease in the incidence of opportunistic infections of the CNS in the ...

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