CLINICAL PROFILE OF CENTRAL NERVOUS SYSTEM OPPORTUNISTIC INFECTIONS IN PEOPLE LIVING WITH HIV/AIDS

Background: Neurological involvement in HIV/AIDS accounts for significant degree of morbidity in a high percentage of people which as per some studies account for 5% to 15% of hospitalizations in PLWHA.[1] A clinical spectrum different from Western countries is expected in India,in view of different socioeconomic,cultural and demographic factors. Aims and Objectives: To study the clinical profile of central nervous system opportunistic infections in PLWHA. Materials and Methods: Study setting – Inpatient Department of Medicine of a tertiary care hospital in Jaipur,Rajasthan between July 2022 to February 2024;clinical profile of 64 patients admitted with neurological symptoms and/or signs associated with HIV/AIDS were studied.Results:Mean age 32.89 ± 9.21 years (range 18-61 years) and median age of our patients was 32.5 years. Subjects in our study were 42.18 % males and 57.81 % females. 34 patients in our study had CNS tuberculosis, 11 patients had CNS toxoplasmosis, 14 patients had Cryptococcal meningitis, and 5 patients had Progressive multifocal leukoencephalopathy. Headache was the most common presenting symptom. Four patients (three tuberculous meningitis and one cryptococcal meningitis) were lost to follow up after discharge. Total of 15 patients expired in our study. Mortality rate were as follows: CNS tuberculosis 19.3%, CNS toxoplasmosis 18.1%, Cryptococcal meningitis 38.4%,Progressive multifocal leukoencephalopathy 40%.Mean CD4 count of expired patients was 46.33 ± 30 cells per mm3 while mean CD4 count of all patients included in our study was 105.93 ± 77.17 cells per mm3. Conclusions: 1) Predominantly young adults between age group of 21 to 40 years are affected by central nervous system opportunistic infections in HIV patients. 2) Tuberculosis is the most common central nervous system opportunistic infection in our study. 3) Disseminated tuberculosis in people living with HIV/AIDS have poor mortality outcome when compared to patients with CNS tuberculosis. 4) CNS toxoplasma and cryptococcal meningitis have similar incidence in our study but prognosis differs. 5) Patients with progressive multifocal leukoencephalopathy had the worst mortality rate. 6) Low CD4 count (< 50 cells per mm3) in the presence of any central nervous system opportunistic infection in HIV patients is associated with high mortality rate.(p< .00001)