Published: 2016-12-24

Neurological manifestations in HIV positive patients attending tertiary care teaching hospital in Western India

Shripad R. Kausadikar, Anand Chandak, Pramod Jha


Background: Neurologic manifestations affecting the nervous system at all levels and stages of HIV infection are common and increasing with the extended survival of HIV-positive persons. Neurological manifestations occur due to either primary pathologic process of HIV or secondary to opportunistic infection. The neurological manifestations of HIV disease are likely to be different in Indian patients because of prevailing endemic infections, malnutrition, poverty and illiteracy. The present study was conducted to study various neurological manifestations in HIV positive patients presenting to tertiary care teaching institute.

Methods: This was observational study of 100 HIV infected patients with clinical evidence of CNS involvement. A detailed clinical history and CNS examination was carried out. CD4 counts were measured and magnetic resonance imaging (MRI), brain/electromyography, nerve conduction studies and cerebrospinal fluid (CSF) examination were done as required for diagnosis. Results were analysed by using percentage and proportions whenever necessary.

Results: HIV induced primary illness was present in about 27% cases, while 73% associated with secondary CNS manifestations were mainly due to opportunistic infection. The most common primary illness was distal symmetrical polyneuropathy (17%) followed by myopathy (6%). On the other hand, the most common secondary CNS infection was tuberculous meningitis (TBM; 30%), followed by cryptococcal meningitis (7%), and cerebral toxoplasmosis (4%). The commonest neurological presenting symptoms were headache (38%) whereas the commonest abnormal neurological finding was presence of signs of meningeal irritation (46.5%). The commonest abnormality found on neuroimaging was meningeal enhancement (32%).

Conclusions: High index of suspicion of neurological involvement in HIV patients in all stages helps in early diagnosis and timely institution of specific therapeutic treatment which in turn may considerably reduce the morbidity and mortality due to the disease.


HIV positive patients, Neurological manifestations, Tertiary care teaching hospital

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