Pattern And Outcome Of Neurological Manifestations Of Hiv/Aids - A Review Of 154 Cases In A Nigerian University Teaching Hospital - A Preliminary Report

Abstract

Background
The HIV is neurotropic and clinicians need to be aware of its myriad neurologic manifestations, as these may be the only clinical presentation.
Objective
To evaluate the clinical spectrum and outcome of the neurologic manifestations in patients with HIV / AIDS over a ten year period.
Design
case - note based retrospective follow-up study.
Settings
Olabisi Onabanjo University Teaching Hospital; Nigeria.
Participants
Patients attending the HIV outpatient clinic and medical in-patients with AIDS.
Intervention
Treatment was symptomatic and specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used routinely.
Main Outcome Measure
Neurologic impairment related to HIV / AIDS and its sequelae within 6 months.
Results
A total of 362 patients with HIV / AIDS were reviewed over a ten-year period, of which 154 patients, (42.5%) had neurological manifestations. Forty-five (29%) patients had Herpes zoster, 40 (26%) had TB meningitis (TBM), 19 (12%) had vacuolar myelopathy (VM), another 19 (12%) had AIDS dementia complex (ADC), 15 (9.7%) had toxoplasma encephalitis, 10 (6.5%) had distal sensory polyneuropathy, 4 (2.6%) had inflammatory demyelinating polyneuropathy, and 2 (1.3%) had subacute combined degeneration of the spinal cord. An overall 6-months fatality of 45% was recorded with ADC, VM and TBM as predictors of high fatality.
Conclusion
Herpes zoster appears to be the commonest neurological manifestation while TBM is the commonest AIDS defining illness. Our experience indicates that unusual neurological manifestations could be the first manifestation of HIV/AIDS, and there is need for awareness of these entities by practising doctors for prompt diagnosis and treatment. Screening of all patients with Herpes zoster for HIV is also advised.
Introduction
Le VIH est neurotrophique et les praticiens doivent être vigilants compte tenu du caracère polymorphe des manifestations neurologiques cliniques.
But
Evaluer les aspects cliniques et l\'évolution des manifestations cliniques chez des patients HIV/SIDA durant une période de 10 ans.
Méthodes
Il s\'agit d\'une étude rétrospective réalisée à l\'Olabisi Onabanjo University Teaching Hospital (Nigeria) chez des patients en ambulatoire pour les séropositifs ou hospitalisés, pour les sidéens. Le traitement était symptomatique et rarement trithérapie.
Résultats
362 patients VIH / SIDA ont été étudiés sur une période de dix ans. 154 patients (42.5%), présentaient des manifestations neurologiques. Quarante cinq patients (29%) avaient un zona, 40 (26%) une méningite tuberculeuse (TBM), 19 (12%) une myéopathie vacuolaire (VM), 19 (12%) une démence (AIDS dementia complex, ADC), 15 (9.7%) une toxoplasmose cérébrale, 10 (6.5%) une polyneuropathie distale sensitive, 4 (2.6%) une polyneuropathie démyélinisante inflammatoire, and 2 (1.3%) une myélopathie subaiguë subacute.
Conclusion
Le zona apparaît comme étant la manifestation neurologique la plus commune. Notre expérience montre que les manifestations neurologiques inhabituelles peuvent être les premières manifestations du VIH/SIDA et interpelle tout médecin en présence de tout malade atteint d\'un zona.

Keywords: Africa, AIDS, HIV, Nigeria, Neurological, Afrique, neurosida, VIH, SIDA

African Journal of Neurological Sciences Vol. 24 (1) 2005: pp. 29-36