Central nervous system infections in HIV-infected patients hospitalized at King Chulalongkorn Memorial Hospital

Abstract

Background: Central nervous system (CNS) infections are among one of the most common complications in HIV-infected patients. The present study aimed to determine the etiologies, clinical features, treatment, and outcomes of all CNS infections in HIV-infected patients.

Material and method: A retrospective study was carried out in all adult HIV-infected patients with CNS infection who were hospitalized at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from January 1, 2007 to December 31, 2008. Medical records ofthe patients were identified by extensively searching the disease codes based on International Classification ofDiseases-10, all microbiological data, and all histopathological data.

Results: One hundredforty eight patients were enrolled. There were 103 males (69.6%) with the mean age of 36.1 +/- 8.9 years (range 15 to 75 years). Among 93 patients with available data, the median and percentage of CD4 cell count during hospitalization were 64.0 cells/microlitre and 6% (range 1-684 cells/microlitre and 1-57%). Among 106 patients with known HIV infection, 67 patients (63.2%) had received antiretroviral therapy with the mean duration of 1.6 +/- 2.1 years. The most common CNS infection was cryptococcal meningitis (56 patients, 37.8%), followed by tuberculosis (53, 35.8%), toxoplasmosis (19, 12.8%), progressive multifocal leukoencephalopathy (6, 4.1%), varicella-zoster virus (VZV) meningitis (4, 2.7%), brain abscess (3, 2.1%), cytomegalovirus radiculomyelitis (2, 1.4%), pneumococcal meningitis (2, 1.4%), herpes simplex encephalitis, Epstein-Barr virus-related primary CNS lymphoma, and HIV-associated myelopathy (1 patient, each, 0.7%). Twenty-two patients died, accounting for the mortality rate of 14.9%. Of these 22 patients, tuberculous meningitis was the most common cause (9 patients, 16.9%), followed by cryptococcal meningitis (9, 16.1%), VZV encephalitis, Aspergillus brain abscess, herpes simplex encephalitis, and pneumococcal meningitis (1, 4.8% each).

Conclusion: To the authors' knowledge, this is the first comprehensive study in Thailand to investigate the etiologies, clinical manifestations, and outcomes of all CNS infections in AIDS patients. There are a high number of patients with tuberculosis and severe immunodeficiency in the present study. The authors' findings suggest an urgent need to actively search and treat most HIV-infected patients in the community before they become severely immunocompromised.