EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

  • ARUN SINGH TEJAVATH Department of Gastroenterology, NIMS University Rajasthan, Jaipur, India.
  • AMIT MATHUR Department of Gastroenterology, NIMS University Rajasthan, Jaipur, India.
  • PRATIMA SINGH Department of General Medicine, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India.
  • SUPRIYA SUMAN Department of General Medicine, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India.
  • PREETI RAJ Department of General Medicine, NRI Medical College and General Hospital, Guntur, Andhra Pradesh, India.
  • MURALI VENKATESHWARA T Department of Pharmacy Practice, NIMS University Rajasthan, Jaipur, India.

Abstract

Objective: The objective of the study was to describe, evaluate, and analyze neurological manifestation in human immunodeficiency virus HIV positive patients admitted to a tertiary care center.


Methods: The study was a prospective cross-sectional study, in which 103 HIV patients were analyzed. All patients were interviewed face to face and evaluated by the investigator with particular reference to neurological manifestations. They were classified into various stages of HIV using the World Health Organization staging system.


Results: The mean age in males was 37 (standard deviation [SD] 8.0) years and in females 35 (SD 7.0) years. A greater proportion of females were diagnosed in the asymptomatic state during screening, either during pregnancy or when the spouse was found to be positive. Headache was the most common neurologic symptom and fundus abnormalities were the most common neurological sign documented in patients. The mean CD4 counts in males are 156.5/mm3 and in females are 229.57/mm3 whereas the mean absolute leukocyte count in males is 1088.30/mm3 and in females is 1473.52/mm3. The CD4 counts showed a better correlation with the occurrence of neurological manifestations than absolute leukocyte count.


Conclusion: Headache was a significant predictor of the occurrence of neurological complications (p=0.01). CD4 counts were significantly lower in patients with neurological complications and most of the neurological manifestations; on the contrary, all the opportunistic infections were documented in patients with CD4 counts below 200/mm3. Neurological complications did not show any correlation with the patient being on anti-retroviral therapy.

Keywords: Cryptococcal meningitis, Human immunodeficiency virus/AIDS, Neuro-infections, Toxoplasmosis, Tuberculosis

References

1. Simoes E, Babu P, John T, Nirmala S, Solomon S, Lakshminarayana C, et al. Evidence for HTLV-III infection in prostitutes in Tamil Nadu (India). Indian J Med Res 1987;85:335-8.
2. Sandeep B, Chavan VR, Raghunathan M, Arshad M, Sayana SB. Factors influencing the substitution of art in HIV/aids patients on first line highly active antiretroviral therapy. Asian J Pharm Clin Res 2014;7:117-20.
3. Aher A. HIV and AIDS in India. Brighton, United Kingdom: Avert; 2020.
4. Patrick M, Johnston J, Power C. Lentiviral neuropathogenesis: Comparative neuroinvasion, neurotropism, neurovirulence, and host neurosusceptibility. J Virol 2002;76:7923-31.
5. Bensalem M, Berger J. HIV and the central nervous system. Compr Ther 2002;28:23-33.
6. Deshpande A, Patnaik M. Nonopportunistic neurologic manifestations of the human immunodeficiency virus: An Indian study. J Int AIDS Soc 2005;7:2.
7. De S, Marsh J. HIV-1 Nef inhibits a common activation pathway in NIH-3T3 cells. J Biol Chem 1994;269:6656-60.
8. Lanjewar D, Jain P, Shetty C. Profile of central nervous system pathology in patients with AIDS: An autopsy study from India. AIDS 1998;12:309-13.
9. Suryana K, Suharsono H, Budiasa G, Antara J, Astuti P, Indah I, et al. Correlations between cluster differentiations 4 counts, human immunodeficiency virus clinical stages, and haemoglobin level among human immunodeficiency virus patient patients with anemia in Merpati clinic, Wangaya hospital, Denpasar, Bali Indonesia: A cross-sectional. Asian J Pharm Clin Res 2019;12:426-9.10. Wadia RS, Pujari SN, Kothari S, Udhar M, Kulkarni S, Bhagat S, et al. Neurological manifestations of HIV disease. J Assoc Physicians India 2001;49:343-8.
11. Kumar P, Sharma N, Sharma NC, Patnaik S. Clinical profile of tuberculosis in patients with HIV Infection/AIDS. Indian J Chest Dis Allied Sci 2002;44:159-63.
12. Saag M, Graybill R, Larsen R, Pappas P, Perfect J, Powderly W, et al. Practice guidelines for the management of cryptococcal disease. Clin Infect Dis 2000;30:710-8.
13. Graybill J, Sobel J, Saag M, van der Horst C, Powderly W, Cloud G,et al. Diagnosis and management of increased intracranial pressure in patients with aids and cryptococcal meningitis. The NIAID mycoses study group and AIDS cooperative treatment groups. Clin Infect Dis 2000;30:47-54.
14. Satishchandra P, Nalini A, Gourie-Devi M, Khanna N, Santosh V, Ravi V, et al. Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989-96). Indian J Med Res 2000;111:14-23.
15. Levy R, Bredesen D, Rosenblum M. Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of the literature. J Neurosurg 2007;107:1253-73.
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TEJAVATH, A. S., A. MATHUR, P. SINGH, S. SUMAN, P. RAJ, and M. VENKATESHWARA T. “EVALUATION OF NEUROLOGICAL MANIFESTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-AIDS PATIENTS ADMITTED TO SOUTH INDIAN TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 11, Aug. 2020, pp. 86-90, doi:10.22159/ajpcr.2020.v13i11.38968.
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